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NAVMED P-5088 




Vol. 45 



Friday, 12 February 1965 



No. 3 




CONTENTS 



MEDICAL ABSTRACTS 

Malpractice and the Service Doctor 1 

Beware of Urologic Complications In Pregnancy 5 

FROM THE NOTE BOOK 

American Board of Ob-Gyn 7 

In the Spotlite 7 

AF1P Hosts Annual PG Course 7 

Naval Medical Research Reports 8 

DENTAL SECTION 

Report of Survey on Teaching Anesthesia in Dental 
Schools 10 

Clinical Evaluation of Amalgam Cavity Design „_ 10 

Effect of Multiple Stannous Fluoride Treatment on 
Caries Incidence in Children 11 

Bone Resorption After Immediate Dentures and After 
Conventional Dentures 11 

New and Modified Devices for Use in Oral Surgery 1 1 



DENTAL SECTION (Cont'd) 

Dental Caries 

Personnel and Professional Notes 

OCCUPATIONAL MEDICINE 

Automobile Injuries — A National Epidemic 

SPECIAL ARTICLE 

United States Navy Toxicology Unit 

RESERVE SECTION 

Medical Service Corps 

MISCELLANY 

The Effects of Antidepressant Drugs 

Adaptation of Oral Birth Defects 

BUPERS NOTICE 1 120 

Hospital Ship Change of Command 

The Fetal Life Study 

American Board Certifications 



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United States Navy 
MEDICAL NEWS LETTER 



Vol. 45 



Friday, 12 February 1965 



Rear Admiral Edward C. Kenney MC USN 
Surgeon General 

Rear Admiral R. B. Brown MC USN 
Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 
William A. Kline, Managing Editor 

Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section ■ Captain C. Cummings MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 



No. 3 



Policy 

The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such information. The items 
used are neither intended to be, nor are they, sus- 



ceptible to use by any officer as a substitute for any 
item or article in its original form. All readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual 

Change of Address 

Please forward changes of address for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 
addresses. 



FRONT COVER: The U.S. Naval Hospital, St. Albans, New York, was commissioned on 15 February 1943. The 
original plans in 1942 were for building a permanent hospital to be situated on 117 acres of ground, formerly 
the St. Albans Golf Club and Community Center. Ground was first broken in May of that year for a permanent 
building of 1 ,000 beds but, with the progress of the war, the Navy soon saw that far greater accommodations 
would be needed. Accordingly, work on the permanent hospital was suspended and plans were hastily revised 
for temporary structures with 1,500 beds. On the day of commission, the hospital census was already up to 1,100 
patients and soon after, war casualties began arriving from all over the theatres. On 1 January 1944 the census 
showed 3,942 patients and on the same date in 1945 there were 5,200. 

In 1948 construction began on the permanent building which was commissioned on 15 August 1951. 

As well as providing all types of specialty care, this hospital is designated as a center for cancer, tuberculosis, 
and neurosurgery. 

There are both intern and residency training programs available. — Editor. 

The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 

U.S. NAVY MEDICAL NEWS LETTER 



MALPRACTICE AND THE SERVICE DOCTOR* 



LCOL Raymond Coward JAGC USA** 1 United States Armed Forces Medical Journal 
IX (2): 224-240, February 1958. 



Malpractice and professional liability are matters of 
direct concern to every member of the medical profes- 
sion, whether he is engaged in private practice or is a 
doctor serving in the Armed Forces. At common law 
there was no duty on the part of the doctor to render 
medical care to an ill person, and the law in this country 
imposes no liability on the doctor for refusing to take a 
case, but once medical care is undertaken by the doctor, 
he becomes responsible for his acts. This is true even if 
the patient is a charity case. 

Recognizing that he should practice his profession 
with the welfare of the patient uppermost in mind, the 
doctor asks how he can do this and still protect him- 
self against malpractice claims. Are these two con- 
cepts incompatible? How is the service doctor affected 
by malpractice claims as compared to the private prac- 
titioner? Should a medical officer carry malpractice 
insurance? Are there definite steps that can be taken 
or procedures which may be followed by either a private 
or service doctor that will furnish substantial protection 
to him and either reduce the likelihood of malpractice 
claims or avoid them altogether? 

The realization that these and related questions are 
constantly in the minds of doctors has prompted the 
writing of this article in an effort to help the individual 
doctor, and particularly the medical officer, to arrive 
at sound conclusions with respect to this complicated 
medico-legal field. Some of the principles discussed are 
applicable not only to the medical officer but also, under 
certain circumstances, to the service dentist, nurse, or 
other member of the medical team, after making al- 
lowance for the different standards of education, train- 
ing, experience, and knowledge applicable to the dif- 
ferent professions. 

Definitions 

What is malpractice? it has been defined as: "Any 
professional misconduct, unreasonable lack of skill or 
fidelity in professional or fiduciary duties, evil practice, 



* From Legal Office, Office of The Surgeon General, Department 

of the Army, Washington, D.C. 
** Colonel Coward is now retired from the Army and lives at Searcy, 
Arkansas. 



or illegal or immoral conduct." 1 More specifically, as 
applied to physicians and surgeons, it means bad, wrong, 
or injudicious treatment of a patient, professionally and 
in respect to the particular disease or injury, resulting 
in injury, unnecessary suffering, or death to the patient, 
and proceeding from ignorance, carelessness, want of 
proper professional skill, disregard of established rules 
or principles, neglect, or a malicious or criminal intent. - 

The term malpractice appears to be used more and 
more by the courts as though synonymous with negli- 
gence on the part of the physician, surgeon, dentist, 
or nurse. Negligence is: "The omission to do something 
which a reasonable man, guided by those ordinary 
considerations which ordinarily regulate human affairs, 
would do, or the doing of something which a reasonable 
and prudent man woud not do."' 1 

In general a legal action based on negligence (mal- 
practice) is founded on a tort as distinguished from an 
action on a contract as a result of an agreement between 
the parties concerned. However, the action may be 
based on a contract in an instance where the doctor 
agreed to cure or to make a specified improvement in 
the patient's condition and failed to do so as a result 
of his medical treatment. 

A tort is defined as: "A wrong independent of 
contract. A violation of a duty imposed by general law 
or otherwise upon all persons occupying the relation 
to each other which is involved in a given transaction." 4 
Three elements of every tort action are: existence of a 
legal duty from defendant to plaintiff, breach of duty, 
and damage as approximate result."' 

RES IPSA LOQUITUR 

With respect to negligence cases there is a doctrine in 
the law known as "res ipsa loquitur" or "the thing speaks 
for itself." In malpractice proceedings, plaintiffs and 
their attorneys often encounter difficulty in obtaining 
the services of experts in the medical and nursing pro- 
fessions to testify that a colleague was negligent. The 
doctrine of res ipsa loquitur is a great assistance to the 
plaintiff under such circumstances. Except for this doc- 
trine how could plaintiffs otherwise prove that paralysis, 



U.S. NAVY MEDICAL NEWS LETTER 



burns, foreign substances in the abdomen, and other 
such conditions were the result of negligent acts? 

Three conditions are necessary for the rule of res 
ipsa loquitur to apply: (1) The accident is of a kind 
that does not occur in the absence of someone's negli- 
gence; (2) the injury is caused by an instrumentality 
within the exclusive control of the defendant; and (3) 
the accident is of a kind that the plaintiff could not have 
contributed to by his conduct. How this doctrine is 
applied depends on the law of the particular state. In 
some states proof of the three required conditions is 
considered as circumstantial evidence, and negligence 
may be inferred. In other states proof of these three 
conditions creates a presumption of negligence and 
places the burden on the defendant to overcome the 
presumption. A presumption is a deduction which the 
law requires the trier of facts to make, an inference 
being a deduction which the trier may or may not 
make according to his own conclusions; a presumption 
is mandatory, an inference permissible. 6 

A leading case in the United States on the doctrine of 
res ipsa loquitur as applied to malpractice suits is that of 
Ybarra v. Spangard.' The essential facts in this case are: 

Plaintiff entered a private hospital for an appendec- 
tomy to be performed by the defendant. On the day of 
the operation he was wheeled into the operating room 
by a nurse who was an employee of Dr. Swift, who 
owned the hospital. The anesthetist, also an employee 
of Dr. Swift, adjusted plaintiff for operation, pulling his 
body to the head of the operating table and laying him 
back against two hard objects at the top of his should- 
ers, about an inch below his neck. The anesthetic was 
administered and plaintiff lost consciousness. He awoke 
next morning in his room attended by two nurses, also 
employees of Dr. Swift. 

Plaintiff testified that prior to the operation he never 
had had any pain in, or injury to, his right arm and 
shoulder, but that when he awakened he felt a sharp 
pain between the neck and the point of the right should- 
er. He received diathermy treatments, but the condition 
spread to the lower part of his arm. He could not lift 
or rotate his arm, and developed paralysis and atrophy 
of the muscles round his shoulder. 

Plaintiff instituted proceedings against the physician 
who diagnosed the case, the owner of the hospital, the 
surgeon, the anesthetist, and the three nurses. After his 
testimony, attorneys for the defendants asked that the 
suit be dismissed on the ground that the plaintiff did not 
prove any defendant to be negligent; and, indeed, by all 
legal standards, he did not. But the plaintiff contended 
that his testimony showed the existence of the three 
conditions necessary to invoke the doctrine of res ipsa 
loquitur, that the inference of negligence was estab- 
lished, and that the plaintiff should prevail. 

The defendants claimed the doctrine did not apply in 
this case; that the condition that the instrumentality 
was in the exclusive control of defendant did not exist, 
and that the doctrine cannot apply where several de- 



fendants are involved and there is a division of re- 
sponsibility. The court decided for the plaintiff and said: 

"But we do not believe that either the number or re- 
lationship of the defendants alone determines whether 
the doctrine of res ipsa loquitur applies. Every defend- 
ant in whose custody the plaintiff was placed for any 
period was bound to exercise ordinary care to see that 
no unnecessary harm came to him and each would be 
liable for failure in this regard. Any defendant who 
negligently injured him, and any defendant charged 
with his care who so neglected him as to allow 
injury to occur, would be liable. The defendant em- 
ployers would be liable for the neglect of their em- 
ployees; and the doctor in charge of the operation 
would be liable for the negligence of those who became 
his temporary servants for the purpose of assisting in 
the operation. 

We do not at this time undertake to state the extent 
to which the reasoning of this case may be applied to 
other situations in which the doctrine of res ipsa 
loquitur is invoked. We merely hold that where a 
plaintiff receives unusual injuries while unconscious 
and in the course of medical treatment, all those de- 
fendants who had any control over his body or the 
instrumentalities which might have caused the injuries 
may properly be called upon to meet the inference of 
negligence by giving an explanation of their conduct." 

This case shows the importance of keeping careful, 
complete, and accurate case histories and records on 
each patient. This is important not only for the civilian 
doctor or nurse but for the service doctor or nurse as 
well. The doctrine of res ipsa loquitur is at issue in a 
large proportion of malpractice cases in litigation and 
is frequently held applicable to individual cases by the 
courts. 

RESPONDEAT SUPERIOR 

The rule of law known as "respondeat superior" or 
"let the master answer" has applicability in malpractice 
cases in certain instances. This rule provides that an 
employer or principal is liable for the torts committed 
by an employee or agent in the course of employment 
or action as an agent. The rule does not absolve the 
employee from liability; rather, it permits the injured 
party to sue both the employee and the employer. 
Frequently the employer is in a better financial position 
and consequently the suit is brought against the employ- 
er or jointly against the employee and employer so that 
the injured party has a better chance of recovering 
damages for his injuries. 

FEDERAL TORT CLAIMS ACT 

It is a general rule of law that a government may not 
be sued without its consent. This is based on the theory 
of sovereign immunity and can be traced back to the 



U.S. NAVY MEDICAL NEWS LETTER 



common law in early English history. It was said, "The 
King can do no wrong," and consequently no one was 
permitted to sue the crown. 

However, the Federal Tort Claims Act" (FTCA) was 
passed by Congress and became effective in the United 
States in 1946. Prior to this, the United States could 
not be sued for negligent acts of its employees or agents. 
This Act created consent of liability on the part of the 
Federal Government where claims are established for 
damage to or loss of property, or for personal injury 
or death, caused by negligent or wrongful act or omis- 
sion of any employee of the Government while acting 
within the scope of employment or office, in circum- 
stances in which the United States, if a private person, 
would be liable to a claimant in accordance with the 
law of the place in which the act or omission occurred. 

The FTCA provides specifically that the acceptance 
by a claimant of an award or settlement shall constitute 
a complete release by the claimant of any claim against 
the United States and against the employee of the Gov- 
ernment whose act or omission gave rise to the claim. 
The FTCA excludes any claim for negligence arising 
out of the exercise of a discretionary function relating 
to policy or interpretation, miscarriage of mails, assess- 
ment or collection of custom duty, quarantine, assault 
and battery, false imprisonment, false arrest, malicious 
prosecution, abuse of process, libel, slander, misrepre- 
sentation, deceit, interference with contract rights, the 
operations of the Treasury, or combat activities of mili- 
tary forces during time of war. It also excludes any 
claim for negligence arising in a foreign country, or in 
the operation of the Tennessee Valley Authority or the 
Panama Canal. 

In effect, the FTCA establishes consent on the part of 
the Federal Government to liability under the rule of 
respondeat superior for negligence of employees com- 
mitted in the course of employment. There is no con- 
sent to being sued for claims arising under the exemp- 
tions stated, A person having a claim for any cause 
other than negligence, as limited, would be in the same 
position as were claimants sustaining negligent injuries 
prior to the enactment of the FTCA, and as are claim- 
ants who have sustained injuries committed by state 
governmental employees. Such claimants cannot insti- 
tute legal proceedings in courts; they are required to 
seek the aid of Congress in case of a claim against the 
Federal Government, or the aid of the appropriate state 
legislature in the case of a claim against a state govern- 
ment, for the enactment of a special law to compensate 
them for damages sustained. 

The United States District Courts have exclusive 
jurisdiction over suits brought under the FTCA; how- 
ever, claims under $1,000 may be compromised and 
settled by the heads of federal agencies and depart- 
ments. The Army has published regulations setting 
forth the procedure for settling these claims." Claims 
over $1,000 may be compromised and settled, but must 



be approved by a Federal Court. Claims not settled 
may be determined by proceedings in court, which must 
be commenced within a specified period of time, de- 
pending on the statute of limitations in effect where the 
cause of action arose, and generally within one year 
from the date of the commission or omission constitut- 
ing negligence. 

Also, certain claimants may file an administrative 
claim, but not a suit, under the provisions of the Mili- 
tary Claims Act of 1943."' This statute has been imple- 
mented by regulations of the Army." Thus a claimant 
may have a remedy under one of the two above named 
Acts. He may also bring an action against the individual 
doctor, but he is more likely to bring the action against 
both the doctor and the United States. 

If an Army or other Government agency doctor is 
sued individually, he may request that the case be re- 
moved to a Federal District Court if the action is 
brought in a state court. ,= In any case where an Army 
doctor is sued individually or sued jointly with the 
United States, a report of litigation, in accordance with 
published regulations, should be submitted to the De- 
partment of the Army." Arrangements may then be 
made by the Office of The Judge Advocate General 
with the Department of Justice for the local United 
States Attorney to make an appearance in the case and 
defend the doctor and the United States. 

If a judgment should be obtained against an Army 
doctor individually, the Department of the Army would, 
in all probability, sponsor a private bill in Congress to 
give him relief. In the past it has not been necessary 
to seek such legislation, as no case has been reported 
where an Army doctor has been held by a decision of 
a court to be individually liable, although bills are now 
pending before Congress to give relief to two Army 
employees held individually liable in traffic cases. If a 
judgment is obtained against the United States, subse- 
quent recovery from the individual doctor is barred 
by the statute." 

A major difficulty in applying the rule of respondeat 
superior is in determining whether the employee was 
acting within the scope of his employment; however, 
"scope of employment" has been defined to mean "act- 
ing in the line of duty" when applied to a member of 
the military forces. 15 The Federal Government therefore 
is liable for the acts of its employees in the same man- 
ner as a private employer is liable. 

A case as to whether the employee was acting within 
the scope of his employment was decided in Watt v. 
U. S., 1 " wherein it was held that the Government was 
not responsible for the negligent operation of a govern- 
ment truck by a sergeant of the National Guard, be- 
cause the man's job description did not provide for his 
driving military vehicles and consequently he was acting 
outside the scope of his employment. In another case, 
Dishman v. U. S.,' : an employee of the Veterans Ad- 
ministration, had carbolic acid poured into his ear for 
an ear pimple by a physician of the Veterans Admini- 



U.S. NAVY MEDICAL NEWS LETTER 



stration. The Court held the Government was liable, 
as the regulation of the Veterans Administration au- 
thorized treatment of minor ailments of employees and 
the physician was therefore acting within the scope of 
his employment. 

The United States would not be liable, even if the 
physician was acting within the scope of his employ- 
ment, if the cause of action falls within one of the 
specific exemptions to the Federal Tort Claims Act. 
One of the exceptions, for example, is an action based 
on assault and battery. This tort is the basis for many 
professional liability suits such as those involving un- 
authorized operations and treatments. In the case of 
Moos v. U. S., 1 " which arose in Minnesota, the plain- 
tiff's right leg and hip were operated on in a Veteran's 
Hospital, when it was his left leg and hip that needed 
the operation. His suit was dismissed as being an action 
for assault and battery and not actionable under the 
FTCA. It should be kept in mind, however, that the 
plaintiff could still sue the individual doctor in a case 
such as this. 

Another type of case excluded under the FTCA is 
any claim for negligence arising out of the exercise of a 
discretionary function relating to policy or interpreta- 
tion. Problems in this area have arisen in the past with 
respect to furnishing medical care to dependents of 
military personnel. The question of what is or is not a 
discretionary function has caused the courts consider- 
able difficulty. It was held in Denny v. U. S. M that since 
admitting dependents of military personnel to govern- 
ment hospitals is discretionary, no action could be 
brought for negligence under FTCA. However, it was 
held in Grigalauskas v. U. S.,' a Massachusetts case, 
that once the discretion is exercised and the patient 
admitted, the discretionary function ceases and the 
Government is liable for any subsequent negligent acts. 
It also was held in Costley v. U. S." 1 that the use of an 
anesthetic containing a harmful substance was not a dis- 
cretionary act and did not fall within the discretionary 
exception under the FTCA. After the Texas City 
disaster, it was held in Dalehite v. U. S. K that action 
against the United States under the FTCA could not 
be maintained, because of the principle of discretionary 
function. Recent decisions of the Supreme Court in the 
case of Indian Towing Co. v. U. S. 23 and in the Eastern 
Airlines case* 4 indicate that the discretionary act ex- 
clusion is now limited to those decisions made on a 
policy-making or planning level, and decisions made on 
an operational level could not be used as a basis for 
denying a cause of action under FTCA, even though 
some discretion is involved. 

The question of whether a serviceman has a right to 
sue under the FTCA was settled in Feres v. U.S. 35 The 
opinion covered three cases. One, Jefferson v. U.S., x 
was a suit by a veteran who had a towel left in his 
abdomen during an operation in an Army hospital 
while he was still on active duty. Another case was 
Griggs v. U.S., 21 which concerned an officer in the 



Army who died after treatment in an Army hospital, 
while the Feres case involved an officer of the Army 
who died in a fire in the barracks. The Court held 
that none of these claims could be maintained under 
the FTCA, because the injured parties were servicemen 
on duty at the time of injury or death. The opinion 
points out that the Government has financially pro- 
vided for members of the Armed Forces in different 
ways and that traditionally members of the armed 
services could not sue the Government for injuries 
received on duty. It would bring chaos to the order 
and discipline of the Armed Forces to allow every 
serviceman to sue the Government for every real or 
fancied wrong he might suffer. 

The limitations discussed with respect to discretion- 
ary functions would apply also to civilian employees 
of the Government. Prior to 1949 it appears that a 
civilian employee could elect to proceed under the 
FTCA or the Federal Employees' Compensation Act* 
In 1949 Congress amended the latter Act so as to make 
it the exclusive means of compensation for a civilian 
employee killed or injured "while in the performance 
of his duty." 3 It will be noted, however, that in the 
case of Dishman v. U.S.™ the Court held that an em- 
ployee of the Veterans Administration could bring 
an action under FTCA for negligence of a physician of 
the Veterans Administration in treating a pimple in 
the ear, as the injury was not incurred in the per- 
formance of duty and therefore was not governed by 
the Federal Employees' Compensation Act Very few 
cases are found which involve claims under the FTCA 
by civilian employees against government physicians. 
This indicates either that such claims are being handled 
under the Federal Employees' Compensation Act or 
that comparatively few civilian employees are being 
treated by government physicians. 

The question may be raised as to whether the enact- 
ment by Congress of the Dependents' Medical Care 
Act 31 is likely to result in more malpractice claims 
against service doctors. Section 103(a) of the Act pro- 
vides: 

Whenever requested, medical care shall be given 
dependents of members of a uniformed service, and 
dependents of persons who died while a member of a 
uniformed service, in medical facilities of the uni- 
formed services subject to the availability of space, 
facilities, and the capabilities of the medical staff. Any 
determination made by the medical officer or contract 
surgeon in charge, or his designee, as to availability 
of space, facilities, and the capabilities of the medical 
staff, shall be conclusive. The medical care of such 
dependents provided for in medical facilities of the 
uniformed services shall in no way interfere with the 
primary mission of those facilities. 

This statute has codified a substantial part of what 
was in the law and pertinent regulations prior to its 
enactment. In addition to setting out the types of 



U.S. NAVY MEDICAL NEWS LETTER 



medical care that may be furnished, it specifically pro- 
hibits or limits others which formerly were prohibited 
or limited by policy and regulation, such as ambulance 
service, domiciliary care, and treatment of nervous and 
mental disorders. The new law specifically provides 
that "any determination made by the medical officer 
... as to the availability of space, facilities, and the 
capabilities of the medical staff shall be conclusive." 



JAMES P. SEMMENS CAPT MC USN 
U.S. NAVAL HOSPITAL, OAKLAND, CALIF. 

James P. Semmens CAPT MC USN, is Chief of Ob- 
stetrics and Gynecology and Chief of Dependents Out- 
patient Service at the U. S. Naval Hospital, Oakland, 
California, and is Visiting Clinical Instructor in Obstet- 
rics and Gynecology at the Medical College of South 
Carolina in Charleston. He is a Diplomate of the 
American Board of Obstetrics and Gynecology and a 
Fellow of the American College of Surgeons and the 
American College of Obstetricians and Gynecologists. 
He is also Chairman of the Committee of Maternal 
Health of the Armed Forces Chapter of the A. C. O. G. 



Consequently, there does not appear to be any manda- 
tory requirement to admit and treat dependents of 
military personnel in military medical facilities, and 
no increase in malpractice claims or suits against 
service doctors of the United States should be ex- 
pected as a result of the enactment of the Dependents' 
Medical Care Act. 
(To be continued.) 




BEWARE OF UROLOGIC COMPLICATIONS 

IN PREGNANCY 

By CAPT James P. Semmens MC USN. Consultant 4(10): 30-32, Nov-Dec 1964. 



Pyelonephritis is the commonest of all complications 
of pregnancy — save that of excessive weight gain. What 
its role is in relation to asymptomatic bacteriuria and as 
a cause of premature birth or toxemia has even the 
experts debating. At the Second International Sym- 
posium on Pyelonephritis held in Boston this last June, 
opinions were divided. Seven studies aimed at answer- 
ing these questions were reported with three substantiat- 
ing a casual relationship, three failing to confirm it, and 
one reporting evidence strongly suggesting such a rela- 
tionship. All agreed, however, that bacteriuria strongly 
predisposes to pyelonephritis in pregnancy, and it is 
even thought to be a latent stage of chronic pyelone- 
phritis. They also felt that bacteriuria is related to toxe- 
mia; one author reported that women with preeclamp- 



tic toxemia had much higher rates of bacteriuria than 
did normotensive women. Dr. Priscilla Kincaid-Smith 
of Melbourne, Australia, reported prematurity rates 
were two times greater (12% as opposed to 5%); still- 
birth and abortion rates, three times greater (10% as 
opposed to 3%); and toxemia, two times greater in 
bacteriuric women. 

One thing we are sure of: our attitudes toward uri- 
nary tract infection are in for a drastic change. For 
example, we are no longer justified in thinking of pye- 
lonephritis as a "minor" complication of pregnancy, al- 
though a good many of us now act as though it were. 
We must treat pyelonephritis more vigorously, not only 
because it may threaten the fetus with premature birth, 
but also because it may shorten the life of the patient 



U.S. NAVY MEDICAL NEWS LETTER 



as the first stage in a chronic renal process. We must 
also be sure that the infection is not really a manifes- 
tation of major renal disease. 

Pregnant women are particularly susceptible to uri- 
nary tract infection because the flow of urine is slowed 
by the dilated and distorted ureters and bladder, made 
atonic by the increased secretion of progesterone and by 
pressure from the enlarging uterus. Typically, in the 
last trimester or shortly after delivery, the patient de- 
velops intermittent high fever and sudden, severe flank 
pain, usually on the right side. 

Examination reveals tenderness in the costovertebral 
angle and albumin, bacteria, and WBCs (pus) in the 
urine. The diagnosis is further confirmed by culture 
and sensitivity studies of the urine. We prefer to obtain 
urine for culture by the mid-stream technique, if the 
patient can be relied upon to obtain it properly. If she 
cannot, we catheterize using sterile surgical technique. 
The important thing is to get the bacteriologic data 
before beginning treatment, for once antibiotics or 
chemotherapeutic agents are given, diagnosis of resist- 
ant organisms or underlying major renal disease is diffi- 
cult. 

CHEMOTHERAPY 

Sulfonamides may be adequate in the middle tri- 
mester, and even in the early part of the third trimester. 
However, I prefer Furadantin (nitrofurantoin) in the 
third trimester, when premature labor is a threat, be- 
cause sulfonamide has been shown to cause a hemolytic 
response in premature infants. Gantrisin is my drug of 
choice when sulfonamides can be safely employed, using 
2 Gm initially and 1 Gm every 6 hours for at least 7 to 
10 days. (I repeat the urine culture at that time.) 
Otherwise, I prefer to prescribe Furadantin in 100 mg 
doses four times a day for 3 days followed by 50 mg 
four times a day for 7 to 10 days. I check the response 
by culture, continuing on 50 mg three times a day as 
long as the microscopic urine or culture is positive for 
bacteria. Like Gantrisin, Furadantin is highly soluble 
and causes few toxic reactions; moreover, it is effective 
against some sulfonamide-resistant organisms. Although 
the illness, in most cases, appears to last less than 14 
days, it is important to continue some form of chemo- 
therapy for the duration of the pregnancy. Otherwise, 
infection tends to recur. 

WHEN SYMPTOMS PERSIST 

Do not hesitate to carry out a simple cystoscopic ex- 
amination or ureteral catheterization during pregnancy, 
if indicated. However, you may delay ureteral cath- 
eterization until ureteral function has been evaluated; 
by injecting indigo carmine intravenously and noting 
its rate of excretion you can determine whether an ob- 
struction is present. When no obstruction is demonstra- 
ble, I leave the ureteral catheters in place for 24 hours 



to establish drainage; this in combination with chemo- 
therapy usually produces immediate relief of the pa- 
tient's acute symptoms. 

Whenever a patient fails to respond to the initial drug 
therapy, dictated by sensitivity response in vitro, you 
should search diligently for a possible underlying renal 
deformity or disease. A scout film K. U. B. and a ten- 
minute urogram with proper shielding of the fetal 
gonads is justified and will suffice in most cases; these 
tests detect chronic pyelonephritis, renal tuberculosis, 
renal tumors, and congenita! anomalies of the vascular 
or renal pedicles. Certainly when dealing with diseases 
of this sort, the slight danger of irradiating the fetus is 
far outweighed by the benefit to the future well-being 
of both the mother and the infant. 

MAJOR UROLOGIC DISEASE 

By far the most common major uropathies are, in 
my experience, severe pyelonephritis (acute and 
chronic), and ureteral calculi. The symptoms are iden- 
tical: chilis, high fever, flank pain, dysuria, and occa- 
sionally hematuria. 

In most patients, the flank pain of pyelitis occurs on 
the right; when it occurs on the left, ureteral calculi or 
congenital anomalies of the urinary tract must be con- 
sidered or ruled out. Acute tenderness in the costo- 
vertebral angle before the twentieth week of pregnancy 
also suggests infection due to obstruction by calculi; the 
same symptom after the twenty-eighth week is more 
typical of infection due to ureteral dilatation and ob- 
struction caused by displacement of the ureter or trigone 
of the bladder by the gravid uterus. 

Although an infection confined to the renal pelvis 
usually responds rapidly to drug treatment, infection in- 
volving the parenchyma does not. Extensive infection 
of this type may even antedate the pregnancy by months 
or years and may require vigorous, continuous drug 
therapy for months before and after delivery. 

I have observed that patients with chronic pyelo- 
nephritis are apt to have small babies. Hence, in any 
patient who has had babies weighing less than 5Vz 
pounds and repeated urinary tract infection, I suspect 
existing chronic renal disease and, if present, initiate 
early therapy. I treated one woman, who had delivered 
prematurely in eight previous pregnancies, with nitro- 
furantoin from the fourth month until term, and she 
delivered a baby weighing 2Vi pounds more than any of 
her previous ones. 

Ureteral calculi are supposed to be rare. Yet while 
I was stationed at the naval hospitals in Charleston, 
South Carolina, and Pensacola, Florida — in an area long 
called the "stone belt" — I saw 12 patients (one in every 
286 deliveries) with ureteral or renal calculi. This is 
also supposed to be a disease of middle age, yet the 
average age of my patients with calculi was 27 and one 
was only 21. 



U.S. NAVY MEDICAL NEWS LETTER 



One third of these patients passed their calculi spon- 
taneously, one third were treated with antibiotics before 
delivery and had surgery afterward, and one third re- 
quired surgery before delivery. Naturally, we prefer to 
postpone surgery, but intractable pain and toxic mani- 
festations may demand surgery during pregnancy. Ten 
of the 12 patients with ureteral calculi delivered living 
infants. 



Two patients studied had renal tuberculosis. The 
diagnosis was made from a K. U. B. and urogram and 
urine culture and guinea pig inoculation of the cathe- 
terized ureteral urine specimens. 

I have tried to make two major points: always be 
alert for urologic infection, symptomatic or otherwise, 
during pregnancy, and when suspicion is confirmed, be- 
ware of underdiagnosis and undertreatment. 



FROM THE NOTE BOOK 



AMERICAN BOARD OF OBSTETRICS 
AND GYNECOLOGY 

Applications and letters of request from previous 
applicants requesting to be scheduled for the forth- 
coming Part I examination of this Board to be given 
July 2, 1965 will be accepted in the Board office up 
until the closing date of February 28, 1965. Applica- 
tions and letters of request postmarked after that date 
will be returned to the sender. 

Application forms and Bulletins may be obtained by 
writing to the office of the Secretary — Clyde L. 
Randall, MD, American Board of Obstetrics and 
Gynecology, 100 Meadow Road, Buffalo, New York 
14216. 

Servicemen applying for the Part I examination are 
requested to submit the name of their Commanding 
Officer. 

Diplomates of this Board are requested to keep the 
Board office informed of address changes, — Training 
Branch, BuMed. 

IN THE SPOTLITE 

CAPT L. L. Isert, Administration Officer of this 
Hospital, recently received a letter of appreciation 
from Admiral E. C. Kenney, Surgeon General of the 
Navy. Presentation of the letter was made by CAPT 
L. L. Haynes, commanding officer, which reads: 

From: Chief, Bureau of Medicine and Surgery 
To: Captain L. L. Isert, MSC, USN 

122190/2300 

Via: Commanding Officer, U. S. Naval Hospital, 

Chelsea, Massachusetts 
Subj : Letter of Appreciation 

1. The Report of the Study Group for Management 
Review of the Bureau of Medicine and Surgery, to- 
gether with reclamas and subsequent reviews have 



all been considered and acted upon by the Chief of 
the Bureau, and appropriate action directed. 

2. At this time it is considered most fitting and proper 
to express my sincere appreciation for the outstanding 
work the study group has accomplished. 

3. Not only will the results involve significant savings 
financially to the Government, but numerous manage- 
ment improvements are being adopted, and in many 
instances unnecessary overlapping and duplication in 
functions will be eliminated. 

4. The thorough, detailed studies made by the mem- 
bers of the Study Group will serve as source material 
and provide guidance for future programs and surveys, 
as well as the immediate benefits to be gained. 

5. You are complimented and commended for a task 
which has been carried out with distinction. 

6. A copy of this letter will be made a part of your 
official record. 

S/E. C. KENNEY 
— NH2 Gauzette, U.S. Naval Hospital, Chelsea, Mass., 
1(2): 4, December 1964. 

AFIP HOSTS ANNUAL PG COURSE 

Washington, D.C, Jan. 5, 1965 (AFIP)— The 
Armed Forces Institute of Pathology will host the 12th 
annual postgraduate course in "Pathology of the Oral 
Regions," to be held at the Institute Mar. 1-5, 1965. 

The course, which will be directed by CAPT Henry 
H. Scofield DC USN, Chief of the Institute's Dental 
and Oral Pathology Division, is designed to provide 
dentists and physicians current information regarding 
the various aspects of oral disease. 

It will be presented by specialists in oral and gen- 
eral pathology, oral surgery, periodontics and dental 
and cancer research. The course will feature dis- 
cussions on developmental disturbances of the head, 
neck and oral region, inflammatory diseases of the 



U.S. NAVY MEDICAL NEWS LETTER 



oral mucosa and jaws, the oral manifestations of 
certain systemic diseases and neoplasms of the oral 
cavity, jaws and salivary glands. The course will be 
supplemented by illustrations of the clinical, roent- 
genographic and microscopic characteristics of those 
factors. Lectures will be correlated with case presenta- 
tions and microscopic seminars. 

Further information regarding the course may be 
obtained by writing: The Director, Armed Forces 
Institute of Pathology, Washington, D. C. 20305. 
— AFIP Technical Liaison Office. 

NAVAL MEDICAL RESEARCH REPORTS 

U.S. Naval Medical Research Institute, NNMC, 
Bethesda, Md, 
I. An Experiment in Maintaining Homeostasis in a 

Long Distance Underwater Swimmer: MR 005. 

13-4001.06 Report No. 2, July 1964. 

U.S. Naval Dental School, NNMC, Bethesda, Md. 
1. Abstracts of Research Reports of Projects Com- 
pleted in Partial Fulfillment of Requirements of 
the General Postgraduate Course and the Resi- 
dency Programs, June 1964. 

U.S. Naval Medical Field Research Laboratory, Camp 
Lejeune, N. C. 

1. Water Discipline and Performance of Marine 
Infantrymen: MR 005.01-0030.4.1, October 
1964. 

2. User Test of "Kwik-Kold" Cold Pack: MR 
005.12-6001.6, October 1964. 

Naval Medical Research Unit No. 4, Great Lakes, III. 
1, Adenovirus Vaccine Studies: MR 005.09-1203, 
August 1964. 

U.S. Naval Aviation Medical Center, Naval School of 
Aviation Medicine, Pensacola, Fla. 

1. Spinal Motor Responses to Acoustic Stimulation: 
MR 005.13-2005 Subtask 4 Report No. 2, 22 
April 1964. 

2. The Relationships Among the Needs and Values 
of Flight Candidates: MR 005.13-3003 Subtask 
1 Report No. 39, April 1964. 

3. The Effects of Coriolis Acceleration During Zero 
Gravity Flight on Certain Hematological and 
Urinary Parameters in Normal and Labyrinthine 
Defective Subjects: MR 005.13-0004 Subtask 2 
Report No. 2, May 1964. 

4. Measurements of the Astronauts' Radiation Ex- 
posure with Nuclear Emulsion on Mercury Mis- 
sions MA-8 and MA-9: MR 005.13-1002 Sub- 
task 1 Report No. 27, May 1964. 

5. Tolerance of Mice X-Irradiated in an Oxygen Rich 
Environment to Explosive Decompression: MR 
005.13-1002 Subtask 2, May 1964. 



6. Visual Control of Habituation to Complex 
Vestibular Stimulation in Man: MR 005.13-6001 
Subtask 1 Report No. 95, May 1964. 

7. An Instrument for Electrocardiographic Area 
Measurements: MR 005.13-7004 Subtask 8 Re- 
port No. 1, May 1964. 

8. Orientation of the Rotation- Axis Relative to 
Gravity: Its Influence on Nystagmus and the 
Sensation of Rotation: MR 005.13-6001 Subtask 
1 Report No. 96, June 1964. 

9. Linear Energy Transfer Spectrum of Proton Ex- 
posure on Mercury Mission MA-9: MR 005.13— 
1002 Subtask I Report No. 28, July 1964. 

10. Redefinition of the Macula Neglecta in Mammals: 
MR 005.13-6001 Subtask 1 Report No. 97, July 
1964. 

1 1 . Magnitude of Gravitoinertial Force, an Inde- 
pendent Variable in Egocentric Visual Localization 
of the Horizontal: MR 005.13-6001 Subtask 1 
Report No. 98, July 1964. 

12. The Inner Ear Anatomy of the Squirrel Monkey: 
MR Monograph 8, July 1964. 

13. Protection of Vibrated Rats Exposed to Explosive 
Decompression, August 1964. 

14. Radiation Monitoring on Project Mercury: Re- 
sults and Implications, September 1964. 

15. The Effect of Changing the Resultant Linear 
Acceleration Relative to the Subject on Nystagmus 
Generated by Angular Acceleration: MR 005.13- 
6001 Subtask 1 Report No. 99, September 1964. 

16. Influence of Labyrinth Orientation Relative to 
Gravity on Responses Elicited by Stimulation of 
the Horizontal Semicircular Canals: MR 005.13- 
6001 Subtask 1 Report No. 100, September 1964. 

17. Dosimetric Evaluation of Data on the Solid Angle 
Breakdown of Shield Thickness for the Apollo 
Vehicle: MR 005.13-1002 Subtask 1 Report No. 
29, August 1964. 

18. Histopathologic Evaluation of a Laboratory 
Primate: The Squirrel Monkey (Saimiri Sciure- 
us): MR 005.13-9010 Subtask 5 Report No. 1, 
August 1 964. 

U.S. Navy Medical Neuropsychiatry Research Unit, 
San Diego, Calif. 

1. Autonomic Changes During Paroxysmal EEG 
Activity: MR 005.12-2304, August 1963. 

2. Similarities and Differences Among Leaders and 
Followers: MR 005.12-2004 Subtask 1 Report 
No. 62-15, 1964. 

3. Clinician Agreement in Assessing for an Unknown 
Environment: MR 005.12-2004 Subtask 1, April 
1964. 

4. Personal History Correlates of Performance 
Among Civilian Personnel in Small Antarctic 



8 



U.S. NAVY MEDICAL NEWS LETTER 



Stations: JVIR 005.12-2004 Subtask 1 Report 
No. 64-4, April 1964. 

5. Supervisor Esteem and Personnel Evaluations: 
MR 005.12-2004 Subtask 1, April 1964. 

6. The Practical Value of a Psychiatric Screening 
Interview in Predicting Military Ineffectiveness: 
MR 005.12-2201 Subtask 1 Report No. 64-7, 
April 1964. 

7. A Re-Analysis of GSR Conditioning: MR 
005.12-2304 Report No. 64-6, May 1964. 

8. An Evaluation of a Popular Leader: MR 005.12- 
2004 Subtask 1 Report No. 63-9, June 1964. 

9. The Validity of Age, Education, and GCT Score 
as Predictors of Two- Year Attrition Among Naval 
Enlistees: MR 005.12-2201 Subtask 1 Report 
No. 64115, June 1964. 

10. Body Size, Self Evaluation, and Military Effective- 
ness: MR 005.12-2004 Subtask 1 Report No. 
64164-14, July 1964. 

U.S. Naval Radiological Defense Laboratory, San 
Francisco, Calif. 

1. Ionic Relationships of the Bioelectrogenic Mecha- 
nism in Isolated Rat Stomach: MR 005.08-1200, 
10 February 1964. 

2. Effect of Partial Hepatectomy on DNA Synthesis 
and Mitosis in Heterotopic Partial Autografts of 
Rat Liver: MR 005.08-1200 Subtask 5, April 
1964. 

3. Effect of Chronic Gamma Radiation on Airbone 
Infection of Mice with Listeria Monocytogenes: 
MR 005.08-5200 Subtask, 2, April 1964. 

4. Chromosome Abnormalities in Liver and Marrow 
of Mice Irradiated with Fast Neutrons, Gamma-, 
and X-rays. Effect of Dose Rate: MR 005.09- 
5200 Subtask 3, April 1964. 

U.S. Naval Medical Research Unit No. 2, Taipei, 
Taiwan. 

1. Japanese Encephalitis in Taiwan: A Review of 
Recent Studies. 

2. Macacanema Formosana N.G., N.SP. (On- 
chocercidae: Dirofilariinae) from Macaca Cy- 
clopsis of Formosa: MR 005.09-1601.3.10, Jan 
1963. 

3. Gastrointestinal Physiology. II. Replacement of 
Stool Losses in Cholera of K and HCO G Ions and 



of H 2 by Oral Solutions. Failure of Oral Na and 
CI Ions to Replace Stool Loss of These Ions in 
Cholera: MR 005.09-1040.1.15, September 1963. 

4. Avian Myxoviruses and Man: Report No. 63-4. 
September 1963. 

5. The Formosan Serow (Capricornis swinhoii 
Gray): MR 005.09-1601.3.22, 15 November 
1963. 

6. Virus Isolations from Mosquitoes on Okinawa: 
MR 005.09-1406.2.3, 19 December 1963. 

7. Malayan Parasitology Survey, 1962: MR 005.09- 
1601.4.1, December 1963. 

8. The Isolations and Characterization of a New 
Influenza Type B Virus on Taiwan, January 1964. 

9. Epidemiology of Helminth Diseases: Clonorchis 
Sinensis (Cobbold, 1875) Looss, 1907 on Taiwan 
(Formosa): MR 005.09-1601.3.25, March 1964. 

10. A Study of Serum Bilirubin Levels and Erythro- 
cyte Glucose-6-Phosphate Dehydrogenase Activi- 
ties in Chinese Premature Infants: MR 005.09- 
1901.2.8, March 1964. 

11. Simplified Preparation of Blood Hemolysates for 
Electrophoretic Determination of Hemoglobin 
Type: MR 005.09-1601.7.6, April 1%4. 

12. Virus Isolations from Mosquitoes in Okinawa: 
MR 005.09-1406 Subtask 2 Report No. 3, April 
1964. 

13. The Pig-Mosquito Cycle of Japanese Encephalitis 
Virus in Taiwan: MR 005.09-1406.2.4, April 
1964. 

14. Intestinal Morphology in Human and Experi- 
mental Cholera: MR 005.09-1040.1.12, May 

1964. 

15. Hapotoglobin Distribution in a Filipino Popula- 
tion: MR 005.09-1601.7.5, May 1964. 

16. Water and Electrolyte Losses in Cholera, May- 
June 1964. 

1 7. A Parasitologic-Epidemiologic Study in Hapung 
Aborigine Village, Taiwan, June 1964. 

18. The Seasonal Succession of Mosquitoes in Taiwan: 
MR 005.09-1406.2.5, October 1964. 

19. The Pig-Mosquito Cycle of Japanese Encephalitis 
Virus in Taiwan: MR 005.09-1406.2.4, October 
1964. 



It is estimated that 1% of all live-born infants have some abnormality of the chromosomes, and that about the 
same percentage have serious diseases or disabilities due to gene mutations. In addition, congenital malforma- 
tions with a multifactorial genetic basis are estimated to occur in 1.5% of all live-born infants and in 1% of 
children at the age of 5 years. — WHO Chronicle 18(12): 474, December 1964. 



U.S. NAVY MEDICAL NEWS LETTER 



DENTAL SECTION 



REPORT OF SURVEY ON TEACHING 
ANESTHESIA IN DENTAL SCHOOLS 

Bruce L. Douglas DDS MA MPH, Chicago, Illinois, 
Jour Den Educ 28(2): 211-213, June 1964. 

A recent study of 48 schools in the United States and 
6 in Canada revealed that of the 54 schools 45 still con- 
duct the teaching of anesthesiology under the auspices, 
of departments of oral surgery. 

Four schools stated that anesthesiology is adminis- 
tered by independent departments of anesthesiology: 
University of Pittsburgh, Loyola University (New Or- 
leans), University of Toronto, and McGill University, 
The Canadian schools were not included in the former 
survey. The reply from 1 of the schools in the United 
States indicated that its independent department of anes- 
thesiology is under the supervision of an affiliated 
hospital and that local anesthesia is taught by the de- 
partment of oral surgery in the dental school. In a 
sense, this pattern eliminates the basis for saying that 
this school has an independent department of anesthesi- 
ology which handles, through administrative mechan- 
isms, all aspects of pain control. 

The obvious points revealed by the study are that 

( 1 ) anesthesia teaching to dental students remains inex- 
tricably related to the teaching of oral surgery, and (2) 
noticeable trends to establish anesthesiology as a sep- 
arate discipline have not developed. 

Additional points are that (1) the theory of anes- 
thesia is buried in the various basic science departments; 

(2) the nature of drugs used in anesthesia is taught in 
most institutions in the course of pharmacology, al- 
though only 1 school of the 54 included this fact in the 
replies to the survey; and (3) general anesthesia, under- 
emphasized in almost all undergraduate dental curricula, 
is frequently handled by an affiliated hospital or medi- 
cal school. 

What does the future hold? A continuation of the 
present relation between oral surgery and anesthesia in 
dental education seems inevitable for at least some years 
to come. This conclusion is based on the fact that there 
is a dearth of qualified persons, other than oral sur- 
geons, to handle the teaching responsibility of operating 
a separate department of anesthesia. Further, most 
dental administrators probably would find it illogical to 
have an oral surgeon teaching anesthesiology, and to 
separate that teaching from the functions of the de- 
partment of oral surgery. 



If an oral surgeon is to teach anesthesia, he can do 
justice to the long-range objectives of the academic 
task only by doing so primarily as a dentist not as a 
specialist. It will be only when anesthesiology and the 
general principles of pain control are taught by den- 
tists, whether they be specialists or general practitioners, 
that students will grasp the fundamental concept that 
these principles apply equally to operative dentistry 
and exodontics — that premedication, local anesthesia, 
and, even, general anesthesia have their places in the 
general conduct of dental practice, and not only in the 
area of oral surgery. When dentists who are not oral 
surgeons teach dental students how to control, alleviate, 
and eliminate pain, then, and only then, will the stu- 
dents take the responsibilities of learning to write 
prescriptions arid of administering drugs to make all 
dental care more tolerable and safer. So long as pain 
control is linked with oral surgery, there are roadblocks 
to the accomplishment of this important objective of 
dental education. 

CLINICAL EVALUATION OF AMALGAM 
CAVITY DESIGN 

L. G. Terkla and D. B. Mahler, University of 

Oregon Dental School, Portland, Jour Den Res 

43(5) Part II: 921-922, Sept-Oct 1964. 

The purpose of this investigation was to evaluate 
certain aspects of amalgam cavity design on the basis 
of clinical performance. Two designs of a Class II 
amalgam cavity preparation in mandibular second bi- 
cuspids were investigated. Design A is described as a 
base cavity (G. V. Black's design) with no retention 
other than the occlusal and proximal dovetails. Design 
B is the same as Design A except for the addition of 
buccal and lingual interproximal retention grooves pre- 
pared with a small tapered fissure bur. According to 
previous laboratory tests where amalgam restorations 
were fractured out of metal model teeth, Design B was 
25 per cent more resistant to fracture than Design A. 
Approximately fifty restorations of each design have 
been placed and evaluated for 1 year. Twenty-eight of 
these restorations have been evaluated at 2 years from 
the time of placement. The amalgam was manipulated 
and carved in accordance with present concepts of 
optimum procedure. The restorations were evaluated 
in the mouth using a 40-power examination microscope. 



10 



U.S. NAVY MEDICAL NEWS LETTER 



No isthmus fractures were observed for either design, 
indicating two possible conclusions: (1) the lack of 
interproximal retention does not make an amalgam 
restoration any more susceptible to clinical isthmus 
fracture than the presence of interproximal retention 
or (2), a 25 per cent decrease in resistance to fracture 
of Design A, as established by laboratory procedures, 
does not appear to lower the resistance of amalgam 
restorations to clinical fracture. These conclusions are 
based on the conditions imposed in this investigation. 



EFFECT OF MULTIPLE STANNOUS 

FLUORIDE TREATMENT ON CARIES 

INCIDENCE IN CHILDREN 

David Bixler and Joseph C, Muhler, Indiana Univ 

Med Cen, Indianapolis, Jour Den Res 43(5) Part II: 

784, Sept-Oct 1964. 

In an earlier report, data obtained from a human 
clinical study were presented to show the effect of 
various combinations of methods of applying SnFi top- 
ically upon dental caries incidence. That report gave re- 
sults at the end of one year. This report is concerned 
with the results at the end of two years. Subjects were 
children ranging in age from seven to nineteen years 
and were divided into five experimental groups. Ap- 
proximately one-half of each group was examined by 
one examiner and one-half by another examiner. 
Groups I, II, III, and IV all received treatment with 
SnFs prophylactic paste. In addition to the prophylactic 
paste treatment, Group II subjects received SnF= denti- 
frice for home use, while subjects in Group III received 
a topical application of 8 per cent SnFz. Subjects in 
Group IV received all three topical SnF 2 treatments. 
Group V subjects received placebo treatments and 
served as controls. All subjects were treated each six 
months. Results after two years show that both exam- 
iners observed quite comparable effects. The SnF= 
prophylactic paste alone gave a 34 per cent reduction 
in dental caries. An addition of only the SnF. dentifrice 
or the topical application did not appear to add to the 
effect of the SnF 3 prophylactic paste treatment. The 
combination of all three stannous flouride treatments 
was significantly more effective than the prophylactic 
paste alone. 

Editor's Note: This again points up the extreme 
importance in the Navy Preventive Dentistry Program 
for the dental officer and technician to impress patients 
of the great need for using a stannous fluoride denti- 
frice during the months following a SnF 3 prophylaxis 
and topical application. The success of the program 
apparently hinges on the "follow through" as borne out 
by the New London study also. 



BONE RESORPTION AFTER IMMEDIATE 

DENTURES AND AFTER CONVENTIONAL 

DENTURES 

Wictorin, Lennart, Royal School of Dentistry, 

Stockholm, Sweden, Acta Radiologica Sup. 228: 

1-97, 1964. Dental Abstracts 9(10): 620, Oct 1964* 

Less resorption of the maxillary alveolar process 
occurs after immediate dentures have been inserted 
than occurs when conventional dentures are received 
after a healing period of three months has passed. 

Several factors probably are responsible. The im- 
mediate denture protects the alveolar process against 
thermal and mechanical injuries during the first phase 
of healing after extractions. The wearing of a well- 
fitting denture is more favorable to the alveolar process 
than is the absence of a denture during the first three 
months after teeth have been extracted. It is easier to 
masticate food with a complete denture than with no 
denture. The denture can also distribute the mastica- 
tory forces over a larger supporting area, and can give 
the tissues more suitable stimuli. During the first few 
weeks after extraction the immediate denture acts as a 
bandage to the sockets. 

It was concluded that most of the difference in bone 
resorption between the two groups was due to the 
different clinical treatment of the groups. 

♦Copyright by the American Dental Association. 
Reprinted by permission. 



NEW AND MODIFIED DEVICES FOR USE 
IN ORAL SURGERY 

CAPT Donald E. Cooksey and CAPT Clifford H. 

Prince, DC USN, Dental Abstracts 9(9): 541-542, 

Sept 1964* 

Three new or modified instruments have been found 
helpful in oral surgery. The first instrument is a mark- 
ing and measuring gauge for determining the direction 
of the original bone cut in vertical osteotomy for the 
surgical correction of malocclusion. It is made of 19- 
guage (0.036-inch) stainless steel bent into a twist so 
that the handle will lie flat against the neck. The tip 
is a simple blunted hook. The leading edge is straight 
with the hook projecting beyond it. Both sides are 
graduated in millimeters and numbered. In use, the 
instrument is hooked into the coronoid notch and 
adjusted to the desired position at the mandibular angle. 
A line is then made on the ascending ramus with gen- 
tian violet to guide the cut. 

The second instrument is a modification of the 
"Army-Navy" right-angle retractor. On extremely long 
ascending rami, the retractor blade of normal length 
does not expose the coronoid notch. This forces the 
surgeon to extend the excision, thus making a large 
facial scar. Also, the normal retractor blade does not 



U.S. NAVY MEDICAL NEWS LETTER 



11 



give adequate space for free use of the straight air- 
driven handpiece customarily used to section the 
mandible. The instrument has been modified to length- 
en the blade and to provide an arch to accommodate 
the handpiece better. 

The addition of these two instruments to the arma- 
mentarium for vertical osteotomy facilitate access and 
orientation in this procedure and improves the lighting 
and visibility. 

The third instrument is a modification of circum- 
zygomatic wire introducer described to the authors by 
George Morin of Georgetown University and illus- 
trated in G. O. Kruger's Textbook of Oral Surgery. 
The original instrument was so designed that the op- 
erator could become disoriented as to the direction of 
the bend in the shaft once the instrument was intro- 
duced beneath the tissues. The thumb rest has been 
placed on the handle in the direction of the bend, mak- 
ing it possible for the surgeon to visualize the direction 
of the bend at all times. When subfacial wires are 
being placed, use of this modified instrument reduces 
operating time by more than half. 

DENTAL CARIES 

Peter P. Dale, JAMA 188: 1024-1025, June 15, 1964. 
Dental Abstracts 9(10): 617, October 1964." 

Dental caries is unique, progressive, unhealing, irre- 
versible, and a concomitant product of civilization 
without regard to age, sex, race or economic status. 

The well-informed, competent dentist with the co- 
operation of his pedodontic patients and their parents 
can easily prevent or control caries. Basically, the 
carious process is a factorial triad consisting of cario- 
genic bacteria, a suitable substrate or diet and a sus- 
ceptible tooth. The process involved (1) the retention 
of fermentable carbohydrates, (2) the presence of 
microorganisms on the tooth surface, and (3) a phys- 
ical or chemical susceptibility of the enamel surface 
to the products of the interaction of (1) and (2). 

The frequency of ingestion and the form of sweets 
are more important than the total amount consumed. 
The amount of caries is related directly to the number 
of between-meal candy eating sessions. The longer the 
carbohydrate is in contact with the tooth surface, the 
greater the opportunity for acid production and subse- 
quent decalcification. If sweets are permitted, it is 
better to ingest them with meals. 

Toothbrushing, ingestion of detergent foods and use 
of nonmedicated oral rinses are recommended because 
of their esthetic value, beneficial effects to the gingivae 
and possible interference with caries activity; however, 
one cannot expect brushing or rinsing alone to prevent 
caries. 



*Copyright by the American Dental Association. 
Reprinted by permission. 



Rational procedures for prevention and control are: 
( 1 ) fluoridation or use of topically applied fluorides in 
the form of solutions, lozenges, chewing gum, denti- 
frices or gels; (2) early, routine, periodic dental ap- 
pointments to condition and educate children and their 
parents regarding the prevention and control of oral 
disease; (3) well-balanced diets with restriction of be- 
tween-meal fermentable carbohydrates; (4) conscienti- 
ous toothbrushing and dental flossing; preferably just 
after meals, and (5) better cooperative planning and 
understanding of caries prevention and control among 
parents, children, pediatricians, schools, parent-teachers' 
associations, the health department and other com- 
munity organizations. 

PERSONNEL AND PROFESSIONAL 
NOTES 

Naval Dental Corps Offers New Correspondence 
Course. The Naval Dental Corps is offering a new cor- 
respondence course, Dental Administration (NavPers 
I0736-B). The U.S. Naval Dental School prepared 
the course, which replaces two former courses, Dental 
Department Administration (NavPers 10736-A) and 
Dental Clinic Administration (NavPers 10401-1). Also 
replaced are the texts for those courses, which included 
a supplement, Fiscal and Property Management in 
Dental Facilities (NavPers 10840). 

The text for the new course, Dental Administration 
(NavPers 10483), is the first naval dental text pub- 
lished in looseleaf form to permit page changing. This 
should prove helpful because improvements in organi- 
zation, administration, and management occur so 
frequently that almost any text covering those subjects 
will contain some information that is outdated even 
before it leaves the presses. 

The new course is designed to inform the dental 
officer of his duties, and of the policies and practices of 
the Bureau of Medicine and Surgery and the Depart- 
ment of the Navy, as they relate to efficient organiza- 
tion, administration, and management of each type of 
dental facility ashore and afloat. 

Dental Administration consists of 11 assignments and 
is evaluated at 22 Naval Reserve promotion and/ or 
retirement points. Enrollment in the course can be 
accomplished by applying on form NavPers 992 direct- 
ly to the Commanding Officer (Code E^13), U.S. 
Naval Dental School, National Naval Medical Center, 
Bethesda, Md. 20014. Inquiries regarding eligibility for 
the course should be sent to the same address. 

New Stannous Fluoride Preventive Dentistry Kits Avail- 
able. The Procter and Gamble Company has discon- 
tinued current Kits #7073 and 7074. 

Two new kits are available. #7088 — Contains 5 lbs 
Special Pumice Mixture, 0.3 gm stannous fluoride — 
2.0 gm pumice scoop, and directions for use. Price 
$10.00. #7089 — Contains 350 gm stannous fluoride, 



12 



U.S. NAVY MEDICAL NEWS LETTER 



0.3 gm stannous fluoride — 2.0 gm pumice scoop, 1.0 
gm stannous fluoride — 0.8 gm stannous fluoride scoop, 
10 cc mixing vial, 1 cc dropper, 100 patient education 
pamphlets, and directions for use. Price $6.00. 

This is f.o.b. destination within the United States 
and terms are net cash. To order write to: Miss K. C. 
Daniels, Procter and Gamble Distributing Company, 
Winton Hill Technical Center, Cincinnati, Ohio 45224. 

U. S. Navy Dental Officer Presentations. CAPT Bruce 
K. Defiebre DC USN, U.S. Fleet Activities, Sasebo, 
Japan, hosted a professional symposium on 19 Nov 
1964. LT William F. Hohlt DC USN, USS AJAX 



(AR-6), presented an illustrated case history of 
Erythema Multiforme. 

The monthly meeting was attended by dental officers 
of the Fleet Activities, Sasebo; USS AJAX, and local 
Japanese dentists. 

CAPT Robert F. Tuck Has Been Called to Head Re- 
serve Branch. CAPT Robert F. Tuck DC USNR, com- 
manding officer of Chicago's Naval Reserve Dental Co. 
9-3 has been called to active duty to head the Reserve 
Branch of the Dental Division in BuMed. He relieves 
CAPT Harry J. Wunderlich DC UNSR. 



OCCUPATIONAL MEDICINE 

AUTOMOBILE INJURIES 
A NATIONAL EPIDEMIC 



Peter Fisher MD, Seattle, Washington. Archives of Environmental Health 9(6): 798- 

805, December 1964. 



An epidemic is a widely diffused and rapidly spread- 
ing disease. Automobile accident injuries fit this de- 
scription in every way. The facts concerning cause and 
prevention of automobile accident injuries are not well 
enough understood. Effective group effort is minimal. 
If the information already known were applied to auto- 
mobile safety and accepted by everyone including pur- 
chasers and drivers of motor vehicles, the automotive 
accident death rates and injury rates could be reduced. 

INCIDENCE 

Slogans and statistics alone make a limited impres- 
sion on the ordinary driver despite the fact that most of 
us have had personal experience with death or impor- 
tant injuries due to motor accidents. Nonetheless, the 
statistics are startling and must be reviewed. There 
occurs, in the United States, from automobile accidents, 
one death every 14 minutes and an injury every few 
seconds. The story of 40,000 yearly deaths is not the 
most important story. More grim is the fate of more 
than a million permanently mutilated survivors each 
year. Estimates of the number vary, primarily because 
of inadequate reporting. Official sources indicate that 
five million people each year are injured sufficiently to 
miss a day of work or seek medical care. Such injuries 
have replaced infectious diseases as the fourth ranking 
cause of death in the United States for all ages, and are 
now number one for children ages five through 14 
years. More than 1VS million people have died from 



automobile injuries in the United States since the in- 
vention of the automobile. Most accidents occur within 
50 miles of home at driving speeds under 40 mph. In 
the United States, on one single day, July 4, 1961, there 
were 504 deaths and 51,000 disabling injuries resulting 
from automobile accidents, including pedestrian injuries. 

SOURCES OF INFORMATION 

Statistical evaluation provides information for future 
planning. Governmental agencies routinely use accident 
reports for this purpose. A new technique, now being 
used consists of extensive analysis by a trained team of 
experts including physicians, engineers, psychologists, 
mechanics, and others to learn the complete case history 
of each accident in consecutive automobile fatalities. 
This includes thorough analysis of the backgrounds of 
the decedents, circumstances of the accident, role of the 
automobile, highway, climate, and motivating factors. 
Extensive sociological investigation of decedents and 
survivors, with psychological testing of the latter, minute 
dissection of the automobiles, extensive autopsy studies, 
analysis of hundreds of photographs of the accident 
scene and equipment involved are all carefully per- 
formed. Very startling information is forthcoming about 
automobile failures, psychological causes, need for high- 
way improvements, and, on occasion, suspicion of sui- 
cide or homicide by automobile. Information can also 
be pieced together to show who was driving, the path of 
projection of all occupants, and the structural corn- 



US. NAVY MEDICAL NEWS LETTER 



13 



ponents of the automobile that caused or contributed to 
death. 

Another approach is by planned collision to learn 
about the structural integrity of the automobile as well 
as passenger dummy and cadaver acceleration and de- 
celeration forces. There have been reviews of patterns 
of automobile injuries relative to specific parts of the 
body, human motivation, and projection patterns of oc- 
cupants. Finally, this information is disseminated pub- 
licly and among interested professional people in the 
form of conferences by leaders in the field. Another 
statistically insignificant but sometimes emotionally 
powerful tool is the old fashioned testimonial, com- 
monly used to promote sales of a commercial product. 
It is being used more and more to tell the story of 
automobile crash survival by prominent people. 

One unique area that yields crash information is the 
sport of automobile racing. This has been a fertile field 
for testing protective devices and automotive struc- 
tural integrity. Proper inspection and maintenance of 
equipment is followed fanatically by most racing driv- 
ers. Oddly enough, no matter how intelligent or com- 
petent race drivers may be, the majority never volun- 
tarily use proven devices for their own safety. All 
current improvements, such as seat belts, helmets, roll 
bars, flame retardant clothing, proper suiting, and shoe- 
ing, have been forced on them. Prerace examination of 
drivers at a professional midget automobile race track 
proved to have only one purpose — to eliminate the 
driver who was drunk. On one occasion at an "Indian- 
apolis type" race, a driver had a full-blown grand mal 
seizure while driving, sustaining severe injuries. It was 
later revealed that this was not the man's first seizure; 
some of his competitors knew this but did not disclose 
it. 

ROLE OF ALCOHOL 

The alcohol factor must be treated as a special point 
of interest because of its important statistical ranking. 
In a controlled study in New York City, it was shown 
that 73% of drivers responsible for accidents in which 
they had died had been drinking. A control group of 
comparable drivers not having accidents showed 26% 
had been drinking. The person under the influence of 
alcohol is the major offender. He repeats and repeats 
the "near miss" until his catastrophe occurs, as statis- 
tically it must. Professional people informed about the 
problems of chronic alcoholism have learned the futility 
of attempting to change this pattern by the use of slogans 
and advertisements. It is becoming obvious that more 
than half of the fatal and injury producing accidents are 
caused by drinking drivers. If there were such clear-cut 
evidence about the cause of cancer, there would be a 
public demand to put an end to it. 

Where does the difference lie between drinking "just 
a little", having driving performance affected, and being 
drunk? This has been studied extensively. There is 



general agreement. Though individual differences do 
exist in the rate of alcohol absorption and performance 
deficit, there is almost complete agreement about the 
physiological significance of the blood alcohol level 
and its relationship to performance. Yet, legal defini- 
tions differ. Generally, a blood alcohol level of 0.15% 
is accepted as proof of significant intoxication caused 
only by rapid ingestion of large quantities of alcohol 
which, in all cases, severely affects performance. This 
figure is undoubtedly liberal — extending individual lee- 
way to a point beyond any shadow of a doubt. In New 
York, the top figure is 0.10% and in Norway, since 
1926, it has been 0.05% . Oddly, in the United States, a 
figure of 0.05% exonerates the individual although it 
is known that, at this level, extensive ingestion of alcohol 
must have occurred and some performance impairment 
can be measured in almost all people. On the average, 
5 oz of 70 proof whiskey produce blood alcohol levels 
of 0.05%, IVi oz, 0.10%, and 10 oz, 0.15%. There 
is evidence to show that impairment begins at 0.03% 
to 0.04%. A marked increase in personal injury acci- 
dents has been reported in people with blood alcohol 
levels of 0.03% to 0.05%. Alcohol as a major cause 
of automobile injuries is not limited to the driver. In 
a study of 200 fatal pedestrian accidents in New York 
City, increasing age and consumption of alcohol were 
the two major identifiable characteristics. About half 
of those involved had measurable blood or brain alcohol 
levels. 

WHAT CAN BE DONE 

Better Control of Drivers. About 80 million auto- 
mobiles are driven today. Seven out of ten people will 
have an important accident within the next ten years, 
a surprisingly low estimate in view of the kinds of 
diseases to which drivers are subject — impaired vision 
and hearing as well as fatigue and the effects of alcohol 
and drugs. 

Drivers may be angry, old and infirm, young and in- 
experienced, or motivated by aggressions which cause 
them to use automobiles as lethal weapons. Another 
group of drivers are simply inattentive and unimpressed 
with safety devices. 

Restrictive programs which have met with some suc- 
cess have been devised in an effort to select drivers who 
may be safe. Since driving is a necessity in the pursuit 
of gainful occupation for most people, drivers do not 
readily submit to examinations that might disqualify 
them; physicians are caught in the middle in attempting 
to keep unfit drivers off the road, for such patients 
merely find other physicians promptly. 

Driver examination and legislation concerning fitness 
are tragically inadequate in most states. Epilepsy is 
a case in point. Many drivers cannot obtain driver's 
permits after a blackout spell although they are on 
adequate suppressive medication and have had no recent 
seizure; yet others with Meniere's syndrome, periodic 



14 



U.S. NAVY MEDICAL NEWS LETTER 



paralysis, or narcolepsy, etc. are unexamined and un- 
restricted. Uniformity of laws and individualization of 
applications are sorely needed. 

Packaging People for Safety. Physical restraint of 
the automobile occupant seems to be the most fertile 
field for changing injury patterns. The physician can 
play a prominent role by advising his patients to install 
and use safety belts just as he advises prophylactic 
vaccinations. Not satisfied with influencing his patients 
alone, a Corvalis, Ore., physician has supplied the spark 
which resulted in the installation of 1,700 seat belts in 
a city of 21 ,000 people. 

What the Air Force is Doing. Since more Air Force 
personnel were being injured and killed from auto acci- 
dents than from aircraft mishaps, an accident prevention 
program was begun by the Air Force. It included 
mandatory basic driver training for those under age 25 
with special training for those assigned driving as part 
of their duties. Local orientation was begun, discussing 
factors peculiar to the area, such as climate and highway 
factors. Helmets were made mandatory for all cycle 
and scooter drivers. Efforts were made to reduce early 
morning accidents by encouraging personnel to return 
to the base earlier and more slowly. This involved 
telephone calls to the homes of personnel toward the 
end of leave time. There was also an extensive investi- 
gation of each fatality. There was an immediate 37% 
decrease in fatalities. In the last three years, it is esti- 
mated that the lives of 400 Air Force personnel have 
been saved through this program. 

PRESENT STATUS OF SAFETY PROGRESS 

Since the human body cannot be redesigned, we 
must turn to change of automobile design. The auto- 
mobile can be sold without restriction or inspection 
despite the fact that it kills thousands and injures 
millions of its customers every year, a dismal and 
probably unmatched record. A motorist should have 
no greater opportunity of buying a car without proper 
safeguards such as safety belts than he should of buying 
uninspected meats. Driving carefully is not enough. 
After a crash investigation, one particular tree was the 
object struck in several serious accidents — and each 
time, a tree surgeon repaired the tree. Cars and roads 
must be made safer. 

Four-wheel and hydraulic brakes appeared in the 
late 1920's; safety glass, all steel bodies, and improved 
steering appeared in the 1930's. From that time on, 
emphasis has been on comfort, power, performance, 
and appearance. Finally, in 1956, safety latches were 
used, the last significant standard improvement until 
very recently. The Ford Motor Company did produce 
and advertise some devices such as seat belt attach- 
ments and recessed steering wheels, but sales dropped 
over the next year, making it apparent that safety did 
not sell, so these ideas were dropped generally. There 



are already many proven practical safety devices not 
used by the automobile industry but there have been 
important strides made by the industry in 1962 and 
1963. 

Experts have pointed out that education takes time, 
but that automobile designs and structure can be 
changed quickly. For two generations, the automobile 
industry has been redesigning its product every year 
but with almost no consideration of performance in 
crash situations although one half the automobiles made 
will be involved in injury-producing crashes. Minimal 
efforts in 1956 produced door locks that will not easily 
open in a collision, preventing passenger ejection. More 
recently, holes were drilled or punched in the floor to 
make seat belt installations for the front seats a trifle 
easier. What is really needed is complete redesign. The 
weirdest fins are harder to make than the safest instru- 
ment panel; the fanciest grille is more expensive than 
the safest automobile seat. 

THE SEAT BELT STORY- 
FACT AND FICTION 

It has been proved without doubt that a restraining 
device will, if properly used, decrease the injury rate 
and usually minimize the extent of injury. These de- 
vices are readily available and inexpensive; yet, only 
about 2% of the driving population has them, less 
than that use them, and very few of these have complete 
protection devices for all passengers despite the fact 
that crash studies fully document the protection offered. 
Movies of human and dummy demonstrations with and 
without restraints demonstrate the value of such devices. 
Belts are particularly important in roll-over accidents, 
which constitute a fifth of all fatal rural accidents, and 
in ejection accidents where an otherwise modest col- 
lision is transformed into a lethal one when the occupant 
flies out the door, strikes his head on the road, or is 
run over by his own or another automobile. 

The question is continually raised — what about fire? 
This is rare in accidents; escape from a belt can be 
accomplished easily and instantly. What if the occupant 
is unconscious? Then, of course, he cannot escape 
unaided with or without a restraining device. This one 
additional fact is often overlooked: In case of fire, 
there has usually been a severe accident. If the pas- 
senger has been restrained, then, he minimizes his 
danger of unconsciousness or inability to move because 
of severe injury. 

What type, make, and grade of seat belt device 
is best? It is generally agreed that a combination of 
lap belt and diagonal strap is the best compromise be- 
tween safety and ease of use. Sweden uses these ex- 
tensively — in fact, belts are never sold singly. Recent 
studies have shown that a diagonal chest strap without 
a lap belt will not restrain sufficiently; it is possible to 
slither out underneath it. It has been shown further 
that the diagonal chest strap is best attached to the 



U.S. NAVY MEDICAL NEWS LETTER 



15 



roof or door post rather than the floor. This type of 
protection is particularly important in the small car 
where the head might strike the windshield or dash- 
board despite adequate hip restraint. Many people 
strongly advocate "going all the way" in the United 
States and not permitting the sale of lap belts without 
diagonal supports. Most experts agree that lap belt 
protection alone in the larger American cars offers 
nearly as good protection and probably is much easier 
to "sell." Belts can be of various materials, shapes, 
and descriptions. Present standards should require a 
5,000 lb test load and no failure of attachments or 
fabric to tear loose. In recent tests, many belts now 
being sold have proved inadequate. However, even 
if a belt should break, it may have already absorbed 
sufficient energy to prevent important personal injury. 
Perhaps the most important consideration of all is 
complete passenger protection. Back seat passenger 
protection in crashes may be more important than front 
seat passenger protection. Often, the back-seat pas- 
senger flies into the back of the front seat, over the 
front seat, or out the front window, or strikes the front 
seat passenger, causing the latter his only injury. A 
youngster standing on the back seat is particularly 
unstable. Back-seat belts and infant harness supports 
are commercially available. Great emphasis is placed 
on child health; yet children are permitted the unneces- 
sary lethal exposure of unrestrained back-seat riding. 

Practically all seat belt users agree that restraining 
devices add to comfort rather than detract from it. The 
devices give a feeling of security and stability and per- 
mits relaxation. No effort need be made to prevent 
buffeting from bumps, turning of corners, or sudden 
stops. The mother driving with her children in the 
back seat is more comfortable than when the children 
jump about, crawl over her, and fight with each other. 

Have seat belts helped reduce injury? The duPont 
experience is an example. By 1960, the E. I. duPont 
de Nemours & Co. had made the use of seat belts 
mandatory on all 1,792 company cars. In that year, 
no time was lost from automobile accident injury, 

DESIGN FOR THE FUTURE 

It has been demonstrated with human subjects that 
a properly restrained person can decelerate from 60 
mph to full stop within three feet without personal 
injury. Less is known about impact survival levels of 
head acceleration in man. Protective head gear is 
being made more and more effective. When an auto- 
mobile comes to a crash halt, a second collision occurs 
within the car milliseconds later. Initial force propels 
the occupant forward with an impact equal to the 
deceleration rate times his own weight. If he weighs 
150 lbs (68 kg), he may strike with an effective weight 
of 15 tons. Instruments have shown readings of 200 
g at peak deceleration. The body is hurled at a straight 
course toward the collision until all motion is stopped. 



16 



All this may take a fraction of a second or may last a 
few seconds. 

Analyses have been made of 45,000 automobile 
injuries, showing the major causes of injury within the 
automobile. Evaluation is difficult because a frequent 
cause of injury may be less important than an in- 
frequent but more serious injury-producing obstruction. 
In the order of importance, injuries are due to: instru- 
ment panel, ejection, windshield, steering assembly, door 
structures, flying glass, backrest of front seat, rear- 
view mirror, front corner post, and top structures. No 
studies of this nature have been reported with the use 
of seat belts. 

Professor Ryan, pioneer in automobile safety, built 
his own car with the following devices added: seat belts, 
hydraulic bumpers independently hinged that would 
absorb and diffuse impact energy, recessed dashboard 
that could not be hit by the knees or head, padding 
under the dashboard, and padded and receding steer- 
ing wheel. Others have added padding of all interior 
surfaces with energy absorbing materials; frame, engine, 
and body structure designed to absorb much of the 
impact energy of collision; recessed control knobs and 
door handles; removal of protruding ornaments in- 
side and out; roll-over bars; air intake and blow by 
exhaust eliminators to decrease the chance of carbon 
monoxide leaking into passenger compartment; collapsi- 
ble steering shaft to give way under the impact of two 
and a half g's; blowout proof tires; antiskid brake sys- 
tem; ash trays and glove compartments which, when 
popped open, will not inflict fearful facial injuries; cush- 
ions and seats which cannot fly about; uniform position 
of control knobs with handles of distinctive design so 
that, even at night, they can be identified by touch. An 
example of such a revolutionary car is the Survival 
Car II outfitted by the Liberty Mutual Insurance Co. 

Other publications have stressed additional equip- 
ment to include padded headrests to prevent whiplash 
types of injury, removal of tinted windshields, use of 
tempered rather than laminated glass, better engineer- 
ing to prevent interference between use of brake and 
accelerator, steering wheel too close, and so forth. Use 
of moving rather than blinking directional signals; 
standardization of rear lamp position, color, and relative 
intensity; use of separate brake light; colored rear- 
light indicator when foot leaves gas pedal; gas pedal 
pressure speed control device without forced governing 
of speed; visual and auditory speed warning devices; 
brake pedal to be used by either foot; rigid bumper 
back-up plate with energy absorbing material between 
it and the bumper; complete wrap-around bumpers 
rigidly attached to frame and having energy absorbing 
padding; fuel-monitor light to warn against inadvertent 
stopping on high-speed highway, 180° forward visi- 
bility from driver's seat; no headlight shades (to mini- 
mize pedestrian injury); rounded hoods to protect 
pedestrians; no sharp hood ornaments; red night light 

U.S. NAVY MEDICAL NEWS LETTER 



illumination of dashboard; recessed ceiling lights; rear 
windshield wipers and defrosters; recessed package shelf; 
roll-over strength in roof; roof padded on inside to 
protect against head injuries; inertia reel seat belts; 
constant radius of curvature in windshield to prevent 
distortion; fuller sweep design of windshield wipers; 
and design of seats moulded to person's natural pres- 
sure distribution. 

WHAT KIND OF GLASS TO USE 

The first true safety glass appeared in the 1920's. 
This laminated glass consisted of two sheets of glass 
bonded to a tough sheet of plastic. It undoubtedly 
saved many lives but can be broken. When penetration 
occurs, the resulting lacerations can be extensive. 
Tempered glass is harder and requires greater force to 
break, but, when it does break, it disintegrates into 
myriads of pea-sized round particles that will not lacer- 
ate. It has been used in the back window since the 
1930's, and, for several years, in side windows. The 
primary objection to its use in front is that, if it is 
struck but does not break up and fall apart, it may 
become completely opaque. This could occur from a 
flying stone in ordinary driving and would be an obvious 
hazard. In addition, glaziers do not like this glass 
because it cannot be cut into various sizes. Entire 
windows made to specifications must be used for re- 
placement. The automobile industry is influenced by 
the facts that it is cheap to make and less likely to 
break. 

SPECIAL STUDIES 

Extensive, costly studies have been performed dupli- 
cating crash conditions using various makes of auto- 
mobiles with planned engineered collisions at specified 
rates of speed, angle, and position of impact and out- 
fitted with anthropometric dummies. Careful analysis 
of all crash forces is made, and extensive pictorial 
measurement is made by at least 25 high-speed cameras 
inside and outside the automobiles, taking pictures at 
the rate of 1,000 or more frames per second. These 
studies have been daring, imaginative, and have pro- 
vided information of incalculable value. A normal speed 
picture of dummy movement in a collision may reveal 
nothing of great interest. Upon review of the same 
picture under extreme slow motion, it can be seen that, 
often, the dummies leave the backseat, fly into the 
front seat under the dashboard, and back again to 
a sitting position on the back seat. These dummies 
are tested with and without restraints, vary in weight 
and size, and are fully instrumented with accelerom- 
eters. These studies confirm the facts that safety door 
latches on all cars since 1952 afford considerable 
protection against ejection. In addition, roll-over acci- 
dents have decreased since there has been a lowering 
of the center of gravity. 



WHAT ELSE CAN BE DONE 

Physicians Can Help. Health Advice regarding auto- 
mobile safety should be part of medical care in the 
doctor-patient relationship and by public forum to 
encourage better car design and set an example for 
better driving, decreased alcoholic intake before driving, 
and to encourage legislation where indicated. The 
special problems of automobile safety are being treated 
as a special course in one medical school — which is 
realistic since automobile fatalities outrank infectious 
diseases as a major cause of death. 

W hat Can Be Done by Insurance Companies. It has 
been suggested, with some wisdom, that insurance com- 
panies could benefit themselves as well as help promote 
safety measures by lowering insurance rates or increas- 
ing benefits for cars with proper safety devices, especially 
seat belts, and by insisting on their use in public carriers 
such as taxicabs. They might recognize, by some sort 
of merit award, accidents involving automobiles where 
safety devices appeared to minimize personal injury. 

What Can Be Done by Government. Strong en- 
couragement can be given free enterprise to promote 
existing safeguards. Legislation can be pushed where 
it seems necessary; law enforcement can recognize the 
merit of use of safety devices and consider such use 
a basis for leniency in dealing with offenders; and all 
government vehicles could set a standard for practice 
in safety device utilization as well as in automobile 
selection. One slightly helpful trend is "Good Samari- 
tan" legislation, holding the physician harmless for 
malpractice suit when he stops to help an injured 
motorist or pedestrian. 

HOW BAD ARE THE INJURIES 

There is much written and gossiped about the "Green 
Poultice Treatment" of spine injuries. This actual phrase 
was used publicly in a paper by a leading physician 
at a medical convention, recently. Engaging in irre- 
sponsible statements and petty debate will not help the 
injured driver nor prevent accidents. False claims 
can be expected. So prominent are the doubters that 
almost the only group of physicians who really under- 
stand the symptoms produced by spine injuries are those 
who have had them. Evidence is abundant showing 
the frequency with which severe fractures are missed in 
physical examination and by x-ray. The fantastic gyra- 
tions and forces applied to the neck region in un- 
restrained subjects undergoing rapid acceleration or 
deceleration can be appreciated only through observa- 
tion of high-speed motion pictures. These devastating 
events can occur with modest impact forces causing 
very little monetary damage to the automobile and 
no immediate signs of injury. Personal accounts by 
responsible people involved in these accidents are legion. 



U.S. NAVY MEDICAL NEWS LETTER 



17 



SUMMARY AND CONCLUSIONS 

A comprehensive review of the present status of 
knowledge of factors relating to automobile injuries 
is presented. The general disregard of proved safety 
measures is emphasized. Suggestions for significantly 
lessening the incidence and degree of injury and fre- 



quency of fatality are presented. Most prominent 
among these is the immediately available, reasonably 
inexpensive, proved method of passenger restraint — the 
seat belt. Almost as important, but much less easily 
achieved in view of past failures, is the need for better 
automobile design, inside and out. 



SPECIAL ARTICLE 

UNITED STATES NAVY TOXICOLOGY UNIT 

NNMC News, NNMC, Bethesda, Md., 20(11) :3, November 16, 1964. 



TOXICOLOGY UNIT PROVIDES REAL 
SERVICE TO FLEET, ENTIRE NAVY 

The U.S. Navy Toxicology Unit started operations 
in October 1959 in response to the urgent need of the 
fleet, particularly the Polaris Fleet Ballistic Submarine, 
for rapid practical answers in the area of toxicology. 

The Secretary of the Navy at the time of its estab- 
lishment stated that the mission of the Unit was "to 
provide technical and specialized services in the fields 
of operational toxicology and health engineering as 
related to toxicity problems encountered aboard ships 
and in the design and use of new weapons systems, and 
to develop and provide biological data necessary for 
determining permissible limits so that precautionary 
measures, conducive to good health practices, may be 
prescribed." 

What do all these words mean? On 17 January 1955, 
less than 10 years ago, the USS Nautilus was the first 
ship to get "underway on Nuclear Power." Since that 
time the Polaris missile system has been developed. The 
26 Polaris submarines we already have in operation 
are a major element of United States deterrent strength. 
In addition, the 20 nuclear powered attack type sub- 
marines in operation are a vital part of our fleet's 
attack and antisubmarine forces. Since the first Polaris 
submarine went to sea in 1960, none has been late in 
deployment, none has aborted a mission, nor has any 
submarine returned early. We would like to believe 
that in a small way, the Navy Toxicology Unit has 
contributed to this magnificent accomplishment. 

Along with the tremendous increase in the capabilities 
of our nuclear powered submarines, many new health 
problems have been generated. Fleet ballistic sub- 
marines, for logistic reasons, must remain submerged 
for long periods of time — at least 60 days. Personnel 
aboard must be given clean air to breathe so as to avoid 
the development of any occupational medical diseases 



18 



and also to make sure that the men can work without 
any degradation in performance. 

The submarine atmosphere in general has been made 
as clean as the air in most cities. This is accomplished 
by standard air-conditioning to control temperature and 
humidity, by scrubbers to remove carbon dioxide, by 
burners to remove carbon monoxide, and by electro- 
static precipitators to remove dust and particulate mat- 
ter. It is interesting to note that the largest amount 
of impurities in the air of a sub are produced by men 
smoking. 

In addition to cigarette smoke there are some 200 
trace contaminants which must be guarded against. 
These would be unimportant in an industrial plant or in 
city air, but become of real concern in the confined 
space of a submarine. In submarines men are exposed 
continuously 24 hours per day, with no chance for 
a "breather," with no opportunity to go home after 
the day's work or to have the weekend off and go fish- 
ing in the country. They must continuously remain in 
the confined space on the sub and breathe the air avail- 
able to them. 

The major objective of the Unit is to screen all ma- 
terials and chemicals going aboard a submarine for 
toxic potential. This includes all operation chemicals 
and equipment such as hydraulic fluids, solvents, paints, 
fast printers, as well as as personal items such as hobby 
kits, shaving creams, lighter fluids and similar gear. 

A specific example may help clarify the role of NTU. 
The Bureau of Ships, after long research, has come up 
with a promising hydraulic fluid which meets all of the 
engineering requirements and now desires to utilize it 
aboard ship. It has no data on the potential health 
hazard and now turns to NTU for assistance. 

The first step in screening a material is to run acute 
studies to see what would happen if the material comes 
in contact with the skin or the eyes, or if accidentally 

U.S. NAVY MEDICAL NEWS LETTER 



swallowed. This is conducted by the staff of the Pharma- 
cology Department on rabbits, guinea pigs, and rats. It 
was learned that paralysis might result if too much of 
the material is introduced into the body. This helped 
to set up safe handling procedures and the necessary 
health precautions in case of an accidental spill. 

The second step is to run long term continuous in- 
halation studies in which various species of animals are 
exposed under simulated submarine conditions. The 
chambers shown are equipped to disperse minute 
amounts of gases, vapors, dusts, and aerosols under 
carefully controlled conditions of temperature and 
humidity. Five species of animals are then maintained 
in these chambers for lengths of time approximating 
those which a sub may be required to maintain sub- 
merged and on patrol. These chambers are non-existent 
elsewhere in the Navy or the military. 

All departments at NTU are involved in inhalation 
studies. One of the most difficult problems is measuring 
the minute amounts of contaminants in the chamber. 
This is done by the Chemistry Department by stand- 
ard laboratory techniques and by the Health Engineer- 
ing Department by means of highly specialized instru- 
mentation. At all times during the study a constant 



check is maintained on the concentration present in the 
chambers. The Pathology Department does blood work, 
organ weights, autopsies, and histopathology; the Bio- 
chemistry Department does enzyme and tissue altera- 
tion studies; the Health Engineering Department is 
responsible for maintaining the prescribed conditions 
in the chamber. 

With this team working as one it was found that if 
the concentration of the hydraulic fluid mist in air 
was held to a certain limit it could be used without 
threat to health, This information was then made 
available to the Bureau of Medicine and Surgery and 
to the Bureau of Ships and guideline limits for safe 
operation were established. 

But there is a third phase. The Unit has a team in 
a constant state of readiness to go aboard ship to 
troubleshoot whenever necessary. 

All animal toxicity studies are preliminary to the 
end-point sought, that is the effect that these military 
chemicals will have on man. Human experience still 
provides the most desirable type of data, but, until 
such time as controlled human experiments are run 
on a long term basis, we will be in a large measure 
dependent upon animal experimentation. 



RESERVE SECTION 



The Medical Service Corps was established with 
the passage of the Army-Navy Medical Services Corps 
Act of 1947 to satisfy a long-standing need for a 
permanent commissioned corps of specialists to com- 
plement the purely professional functions of the Medi- 
cal Corps and Dental Corps. The original legislation 
provided for the Medical Service Corps to be com- 
prised of four sections: The Supply and Administra- 
tion Section, the Medical Allied Sciences Section, the 
Optometry Section, and the Pharmacy Section. The 
Act futher authorized the Secretary of the Navy to 
create such additional sections as necessary and, as a 
result of this authority and as the need was recognized, 
the Women's Specialists Section was established in 
1952 and the Podiatry Section in 1953. 

The Medical Service Corps contains a commissioned 
rank structure of ensign to captain, inclusive. All 
original appointments in the Corps are made in the 
grade of ensign, except for individuals with a doctorate 
degree who may be appointed in the grade of lieutenant, 
junior grade. The professional qualifications for ap- 
pointment in the various sections of the Corps are 
as follows : 

Supply and Administration Section. The principal 
source of procurement for this section is the senior 
hospital corpsmen and dental technicians on active 
duty in the Navy. Eligible enlisted members who 



apply for appointment must meet rigid standards of 
education, background, and performance; pass a 
thorough professional examination, and survive a com- 
prehensive screening process conducted by a Naval 
Examining Board. Appointments in this section are 
also offered to civilian applicants or Naval Reservists 
not on active duty who possess a master's degree in 
hospital administration or public health administration 
or a baccalaureate degree with a major in sanitary 
science. 

Medical Allied Sciences Section. This section is 
composed of officers qualified in professions tradition- 
ally allied to medicine and dentistry, including the 
following: 

Aviation physiology Pharmacology 

Bacteriology Physiology 

Biochemistry Psychology (clinical 
Biophysics and experimental) 

Chemistry Physics 

Entomology Radiation health 

Environmental health Radiobiology 

Hematology Radiochemistry 

Industrial hygiene Radiophysics 

Medical technology Serology 

Microbiology Virology 
Parasitology 



U.S. NAVY MEDICAL NEWS LETTER 



19 



Applicants for appointment in this section, with the 
exception of those in the specialties of aviation physi- 
ology, radiation health, and medical technology, must 
have a baccalaureate degree and have completed a 
minimum of 30 semester hours of graduate work in or 
relating to their specialty. Aviation physiology and 
radiation health applicants must have a baccalaureate 
degree with a major in one of the biological sciences. 
Medical technology applicants must have a baccalaure- 
ate degree and be registered by the American Society 
of Clinical Pathologists. 

Pharmacy and Optometry Sections. Must have a 
baccalaureate degree from an accredited college or 
university with a major in pharmacy or optometry and 
be registered in one of the states or the District of 
Columbia. Optometrists who have passed Parts I and 
II of the National Board of Optometry Examinations 
are not required to be registered. 

Podiatry Section. Must be a graduate of a college of 
podiatry (chiropody) accredited by the American 
Podiatry Association and be registered as a podiatrist 
by one of the states or the District of Columbia. 

Women's Specialists Section. This section is com- 
prised of women officers qualified in dietetics, physi- 
cal therapy, and occupational therapy. Applicants for 
appointment as dietitians must have a baccalaureate 



degree with a major in foods and nutrition and must 
have completed a dietetic internship approved by the 
American Dietetic Association. Physical therapists 
and occupational therapists must possess a baccalaure- 
ate degree and have completed a course in physical 
therapy or occupational therapy approved by the Coun- 
cil on Medical Education of the American Medical 
Association. The Navy also has a student program 
wherein qualified applicants may be appointed as 
Ensign at the commencement of their final 12 months 
of professional training. 

All appointments in the Medical Service Corps, 
except for those individuals appointed from in-service 
sources, are Reserve appointments and may be either 
for active or inactive duty. 

Reserve officers are eligible to apply for a Regular 
Navy appointment after serving on active duty for 18 
months. Medical Service Corps officers on active duty 
are assigned in all geographical and military areas 
wherein a research, operational, or training responsi- 
bility is assigned the Navy Medical Department. These 
areas of assignment include naval hospitals, research 
laboratories, preventive medicine units, Fleet Marine 
Forces, and various ships and stations throughout the 
world. Reserve officers not on active duty may par- 
ticipate in the Naval Reserve Medical Department pro- 
gram in other manners. 



MISCELLANY 



THE EFFECTS OF ANTIDEPRESSANT 
DRUGS 

Antidepressant drugs and their effects, subject of a 
current debate by many doctors, have been analyzed by 
a National Institute of Mental Health psychiatrist. 

Writing in a recent Journal of the American Medical 
Association, Dr. Jonathan Cole, Public Health Service, 
U.S. Department of Health, Education, and Welfare, 
discusses the "current concern" about these potent 
agents. Because of possible side effects and questions 
of efficacy of some of the dozen or so drugs now on the 
market, many experts believe they should be used with 
caution. 

Because of their potency and possible side effects, 
Dr. Cote feels that neither group of antidepressant 
drugs should be the initial treatment for mild depres- 
sions. He suggests instead that treatment be limited 
to a sedative or tranquilizer, with antidepressant drugs 
used only if symptoms persist. 

In a review of 72 studies of the drugs, Dr. Cole, 
Chief of the Psychopharmacology Service Center, con- 
cludes that imipramine and a chemically similar drug, 
amitriptyline, are the most effective of the antidepres- 



sants. Several studies show, however, that they are 
only moderately effective, and occasionally no better 
than placebo treatment and supportive care. 

The imipramine types produce some side effects in- 
cluding dryness of the mouth and excessive perspira- 
tion, but many of these are "annoying rather than 
serious," he writes. 

The evidence for the efficacy of the other major 
group of antidespressants, the monoamine oxidase 
inhibitors, is less convincing, Dr. Cole notes. Some 
depressed patients will respond specifically to them 
after other drugs have failed, but he emphasizes that 
the issue with the inhibitors is whether their therapeutic 
efficacy is sufficient to offset the potential risk. 

Dr. Cole emphasizes that with both the imipramine- 
like drugs and the inhibitors, it is extremely difficult 
to predict which patients will respond successfully. 

He adds that there is little evidence to support the 
efficacy of a third group of so-called antidepressants, 
including such stimulants as the amphetamines, in the 
treatment of depression. 

Dr. Cole concludes that there is some encouraging 
preliminary evidence that the antidepressants may 
serve as valuable preventive drugs. "It may well be in 



20 



U.S. NAVY MEDICAL NEWS LETTER 



the long run that their importance will rest as much or 
more in their ability to avert relapses than in their 
efficacy as initial therapy. In contrast to electro- 
convulsive therapy, these drugs provide a convenient 
means for continued treatment." 

In one controlled study, a six-month followup showed 
that patients maintained on imipramine had a much 
lower relapse rate than those taking a placebo. About 
20 percent of the patients taking the drug relapsed, in 
contrast to 80 percent on the placebo. 

ADAPTATION TO ORAL BIRTH DEFECTS 

Research on the way people adapt physiologically to 
oral birth defects will be undertaken at the Cleft Lip 
and Palate Institute of Northwestern University, 
Chicago, under a grant of $170,000, Surgeon General 
Luther L. Terry of the Public Health Service, U.S. 
Department of Health, Education, and Welfare, an- 
nounced. 

The award from the National Institute of Dental 
Research is for the first year of a projected three-year 
study. Director of the research program is Dr. Stanley 
C. Harris, professor and chairman of the department 
of physiology and pharmacology of the Northwestern 
Dental School. 

Commenting on the new research, Dr. Harris said, 
"Ideal surgical or prosthetic closure of an oral cleft 
would restore normal function if musculature in these 
structures were unaltered. Research in physiology is 
needed to understand normal muscle action, in the 
hope of learning the best methods of repairing an oral 
defect." 

Dr. Harris explained that a technique known as 
electromyography permits measurement of the muscle 
activity of oral structures. "We can make electrical 
measurements of orofacial muscles in cleft palate 
patients and in persons without the defect," he said. 

This project will gather information on differences 
between the breathing, eating, and talking mechanisms 
of normal people and the performance of these func- 
tions in cleft palate patients before and after treat- 
ment. "We hope to find better ways of modifying the 
appearance, function, and psychology of people 
affected with clefts," Dr. Harris stated. 

The major emphasis in the proposed research is on 
establishing the normal range of function in cleft palate 
patients. 

"Deterioration of the timing, symmetry, and con- 
stancy of electromyograms would indicate an un- 
favorable response, whereas a regular and symmetrical 
pattern would indicate competent muscles moving 
normal oral structures," Dr. Harris explained. The 
investigators will attempt to establish criteria for 
surgical and prosthetic management of oral clefts from 
their electromyographic studies. 

In order to explore the causes of oral clefts, Dr. 
Harris and his co-workers will conduct studies of 



formative oral tissues in human embryos and will at- 
tempt to induce cleft lip or palate in animals by drugs 
or by changes in the intrauterine environment. 

In further study of the function of oral structures, 
the investigators will do research on monkeys, some 
of whose oral structures have been altered to mimic 
oral clefts, malocclusion of tooth arch, and even some 
systemic neurological defects. 

Associated with the project will be Dr. Orion H. 
Stuteville, professor of maxillofacial surgery and chair- 
man of the executive committee of the Cleft Lip and 
Palate Institute; Dr. Morton S. Rosen, assistant pro- 
fessor of prosthetics and Director of Cleft Lip and 
Palate Institute; Dr. John R. Thompson, professor of 
orthodontics; Dr. Harold Westlake, professor of speech 
correction and speech pathologist. 

BUPERS 1120 
In Reply Refer To 
Pers B623/aeg 

75-64 

31 August 1964 

BUPERS NOTICE 1120 

From: Chief of Naval Personnel 

Subj: Processing Ensign, 1915, USNR, medical stu- 
dents for the Senior Medical Student and Medi- 
cal Intern Programs 

Ref: (a) CRU1TMAN 

1. Purpose. To provide information concerning the 
procedures that will be followed in processing Ensign, 
1915, USNR, medical students for the Fiscal Year 1966 
Senior Medical and Medical Intern Programs. 

2. Discussion. For the past several years the number 
of applications received from Ensign, 1915, USNR, 
medical students for the Senior Medical Student and 
Medical Intern Programs has been steadily declining. 
It is believed that one factor causing this decline has 
been the inconvenience and expense involved to the 
individual in requiring these applications to be processed 
at a U.S. Navy Recruiting Station or a U. S. Naval 
Hospital. For Fiscal Year 1966 those medical students 
who are presently participating in the Ensign Medical 
Student Program will be invited by the Chief, Bureau 
of Medicine and Surgery, to apply for the Senior Medi- 
cal Student Program or the Medical Intern Program, 
as applicable, by completing and returning to the Chief 
of Naval Personnel application kits provided them at 
their medical schools. Selection will then be contingent 
upon the candidates meeting the prescribed physical 
standards at the time of reporting in compliance with 
their orders. 

3. Action. Action addressees will continue to process 
civilian applicants for the Senior Medical Student and 
Medical Intern Programs in accordance with reference 



U.S. NAVY MEDICAL NEWS LETTER 



21 



(a). If they so desire, Ensigns 1915, USNR, may also 
be processed at U.S. Navy Recruiting Stations or at 
a U.S. Naval Hospital. Orders and/ or appointments 
for selected Ensign, 1915, USNR, medical students will 
be forwarded to the cognizant Naval District Com- 
mandant for delivery by the naval activity nearest to 
the selectees' medical schools which is staffed and 
equipped to perform this function. Orders and ap- 
pointments for selected civilian applicants will be for- 
warded to the cognizant U.S. Navy Recruiting Station 
for delivery. 

4. Cancellation. This Notice is cancelled on 30 June 
1965. 

S/C.D. S1MONSEN 
By direction 

HOSPITAL SHIP CHANGE OF COMMAND 

CAPT Frederick B. Carlson, MC USN, relieved 
CAPT Shakeeb Ede, MC USN, as Officer in Com- 
mand of the Naval Hospital in the USS Haven in cere- 
monies aboard that ship at the U. S, Naval Station, 
Long Beach. 

CAPT Carlson has been serving as Assistant Officer 
in Command and Chief of the Eye, Ear, Nose and 
Throat Service since reporting aboard in Aug. of 1964. 
Prior to his reporting, he served with the U. S. Naval 
Support Activity, Naples, Italy. He resides with his 
wife and family at 1457 Paseo del Mar, San Pedro. 

CAPT Ede, who reported as Officer in Command 
July 5, 1961, is retiring after more than 27 years of 
active naval service. During the ceremonies, RADM 
O.D. Waters, Jr., Commander Naval Base Los Angeles, 
presented CAPT Ede with the Bureau of Medicine and 
Surgery's Certificate of Merit in recognition of CAPT 
Ede's "distinguished and outstanding service to the 
Medical Department of the Navy." CAPT Ede will 
continue his practice of surgery at the Fisher Clinic in 
Long Beach. He will reside with his wife and family 
at 300 Granada Ave., Long Beach. 

At the present time, the Naval Hospital in USS Haven 
serves as the only Naval Hospital in the Long Beach- 
Los Angeles area and is responsible for the care of all 
active duty Navy and Marine Corps personnel and 
retired male personnel, and also for the thousands of 
dependents who are referred for consultation or treat- 
ment on an out-patient basis. — By LT R. S. Ruffin, 
MSC USN, PIO, NH in Haven. 



THE FETAL LIFE STUDY 

Based on findings of the Fetal Life Study (Columbia 
U. & Columbia-Presbyterian Med. Center) in which 
3,200 pregnancies were followed during the years 1953 
to 1957, it may be concluded that "drugs in general" 
are not an important factor in "congenital malforma- 
tions in general." However, since most malformations 
noted in association with drug ingestion by the mother 
during the first trimester of pregnancy could not be 
explained genetically or environmentally, it can not be 
concluded that the drugs had no effect whatever. A 
drug can never be considered absolutely safe — only 
relatively safe. There is a certain degree of calculated 
risk involved in every therapeutic procedure. Physicians 
must always be alert to possible dangers. "Alert clini- 
cians in the past have been our most sensitive warning 
system." The author offers a further word of advice. 
"Awareness of early pregnancy is generally not possible, 
Therefore women at risk of becoming pregnant should 
avoid medication in the latter half of the menstrual 
cycle unless the medical indications are urgent and 
the effectiveness of the procedure well established." — 
Mellin (New York, N. Y.), Am J Obst & Gynecol 90: 
1169 (Dec), 1964. Republished from CL1N-ALERT®, 
No. 1, Jan 7, 1965, by permission of Science Editors, 
Inc. 



AMERICAN BOARD CERTIFICATIONS 

American Board of Pathology 

LCDR Hugh C. Moore MC USNR 
LCDR Richard W. Poley MC USN 
LCDR Luther A. Youngs III MC USN 
LT Kurt W. Mikat MC USNR 
LT Don B. Vollman Jr MC USN 

American Board of Preventive Medicine 
CDR Channing L. Ewing MC USN 

American Board of Thoracic Surgery 
CAPT Donald J. Doohen MC USN 



The use of antibiotics in pregnancy must be viewed with caution, because of their potentially unfavourable effects 
on the pregnant woman and the foetus. — WHO Chronicle 18(12): 450, December 1964. 

There is strong evidence that susceptibility to tuberculosis may, in part, be genetically determined. The possibil- 
ity of genetic differences in susceptibility to leprosy is also quite high, and a genetic element in the determination 
of paralytic poliomyelitis seems to he well established. — WHO Chronicle 18(12): 475, December 1964. 



22 



U.S. NAVY MEDICAL NEWS LETTER 



Atherosclerosis Research Meetings 

Research workers taking part in the WHO organized 
combined epidemiological and pathological studies of 
atherosclerosis met in Geneva for a grading session 
from 1 to 12 July 1964. 

The meeting was called primarily to continue the 
assessment of atherosclerosis in aortae and coronary 
arteries obtained at autopsy from areas in which a high 
proportion of deaths are autopsied. Specimens from a 
further 1500 subjects were graded and various com- 
parability tests were made. Additional tests were carried 
out on material received from the International Athero- 
sclerosis Project in Guatemala to continue comparison 
of grading between the two studies. Dr. Evgenia Ev- 
genievna Matova of Moscow attended as a Research 
Scholar and took part in the statistical control of the 
study. 

A similar grading session was held in Kisinev, Mold- 
avia, USSR, from 26 October to 5 November 1964. 
Problems of combining studies of the living in the same 
areas as the autopsy study were discussed, as well as 
improved methods for assessing heart disease and cere- 
bral lesions and lesions of the intra- and extra-cranial 
cerebral vessels at autopsy. — WHO Chronicle 18(12): 
485, December 1964. 

Automatic Data Processing in 
Health Administration 

A Conference on the Application of Automatic Data 
Processing Systems in Health Administration was held 
in Copenhagen from 17 to 21 November 1964 under 
the auspices of the WHO Regional Office for Europe, in 
cooperation with the Government of Denmark. 

Automatic data processing systems which include the 
use of computers are now beginning to be employed 
in public health administration. In view of the great 
potential value of these systems, it was thought that 
senior public health administrators might welcome an 
opportunity to consider the problems involved in their 
introduction and to discuss possible applications with 
colleagues from other countries. 

In order to provide a clear basis for discussion, the 
Conference held an introductory session during which 
experts defined the terms employed in non-technical 
language. The characteristics of computers and the 
uses to which they may be put were considered, as well 
as the advantages and limitations of computers in com- 
parison with punch-card and other systems. After this 
introductory session, the Conference considered possible 
applications in various branches of public health work, 
the problems of introducing computer systems, and 
possible future developments. — WHO Chronicle 18(12): 
487, December 1964. 

Environmental Health in the USSR 

Nineteen public health experts, including engineers, 
medical officers of health, and health inspectors from 
all six WHO regions, took part in an inter-regional 



seminar on environmental health, held from 7 to 30 
September 1964 partly in Moscow and partly in Tbilisi, 
the capital of the Georgian SSR. 

The seminar — which is part of a programme initiated 
a few years ago by WHO in collaboration with the 
Ministry of Health of the USSR — consisted of 24 lec- 
tures and 18 field visits, during which the participants 
were able to observe at first hand the achievements of 
the USSR in community sanitation, including the sani- 
tary control of water supplies, sewage disposal, solid 
refuse disposal, food sanitation, and housing. They also 
studied measures for the control of noise and atmos- 
pheric pollution, and reviewed the training of sanitary 
physicians and feldshers specializing in municipal hy- 
giene. — WHO Chronicle 18(12): 485, December 1964. 

The Obstetrician's Part in Maternal and 
Child Health Programmes 

A European Symposium on the Role of the Obste- 
trician in Maternal and Child Health Programmes was 
held in Copenhagen from 22 to 29 October 1964. It 
was organized by the WHO Regional Office for Europe 
in view of the increasing need to co-ordinate the work 
of the obstetrician with that of the paediatrician and 
other maternal and child health workers so as to reduce 
maternal, perinatal, and neonatal mortality and morbid- 
ity and prevent low birth weight. 

The Symposium was in the nature of a round-table 
conference with a limited number of participants, in- 
cluding obstetricians from university centres and from 
hospitals attached to community health services, and 
paediatricians with special interest in foetal life and the 
newborn. 

WHO provided the services of a consultant and of 
five temporary advisers (two obstetricians, a medical 
sociologist, a public health administrator, and a nurse- 
midwife). — WHO Chronicle 18(12): 486, December 
1964. 

Organization of Dental Public Health Services 

Dental public health services have today reached a 
fairly advanced stage in some countries. In others only 
a modest beginning has been made, and there are some 
newly emergent countries where the first step has still 
to be taken. Among the countries with well-developed 
services there are considerable differences in organiza- 
tional pattern, but there are undoubtedly some common 
elements that can be defined and used as a basis for a 
generally acceptable organization of dental public health 
services. 

A first attempt to outline such an organization was 
made by a WHO Expert Committee on the Organiza- 
tion of Dental Public Health Services at a meeting held 
in Geneva from 13 to 19 October 1964. It is felt that 
the report of this committee will be helpful to newly 
emergent nations developing their own dental health 
services and will provide other countries with useful 
ideas for the development of the services they already 
have. 



The Committee also examined the needs of dental 
health services in regard to training and research, es- 
pecially those aspects where stimulation or co-ordination 
of action by WHO might be desirable. Two reports of 
WHO Expert Committees have already reviewed the 
training of auxiliary dental personnel and dental educa- 
tion. The recent Committee was concerned more with 
the problem of training in dental public health, bearing 
in mind the possibilities of WHO — sponsored research 
in this connection. 



Consideration was given to the recommendations al- 
ready made by WHO Expert Committees in the general 
fields of public health administration, medical care, and 
public health training, and to the present policies of the 
international Dental Federation, which was represented 
at the meeting by the Chairman of its Commission on 
Public Dental Health Services. 

An account of the Committee's work will appear in 
the WHO Chronicle at such time as its report is pub- 
lished.— WHO Chronicle 18(12): 487, December 1964. 



In a survey of the effects of noise on mental health, it was found that 80% of the population investigated were 
aware of noise in the environment, 25% were troubled or annoyed by it, and 20% complained that it dis- 
turbed their sleep. Standards for soundproofing drawn up in the USSR .specify that the total level of noise in 
houses should not exceed 35 decibels in the daytime and 30 decibels at night. — WHO Chronicle 18(12}: 471, 
December 1964. 



In the first 10 to 15 years after its discovery, penicillin was used or misused on such a vast scale that large 
numbers of people infected with syphilis probably received curative amounts — administered for other purposes — 
during the incubation period of the disease. With the increased production and use of the broad-spectrum anti- 
biotics, which are usually ineffective against syphilis, fewer and fewer people are believed to have been exposed 
to chance prophylaxis against the disease after about 1955.— WHO Chronicle 18(12): 454, December 1964. 



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